Financial Independence Group | 1-800-527-1155

Please take a moment to register for our LTC Bootcamp.
If you have any questions, please contact Beth Charles
at 800.527.1155 extension 132.

Attendee Information:

Attendee Name:
(As it appears on your Passport or State ID)

Street Address:

City:

State:

Zip Code:

Flight Information

Departure Airport:

Alternate Airport:

Arrival Date: / /2009

Depart Date: / /2009

Special Requests:

Other Information:

Will you need hotel accomodations?

Yes

Preferred Bed Type:

Preferred Name:

Phone Number:

Mobile Number:

Emergency Contact:

Emergency Phone:

E-mail address:

Seating Preference:

Window

Aisle

Will you be renting a car?

Yes

Check in : / /2009

Check out : / /2009

Special Request(s):

Do you have any other considerations of which we may need to be aware?

FIG Marketing Consultant:

Will you be attending the July RPM?

Yes

No

Credit Card Information:

Name (on card):

Credit Card Number:

Exp Date:

Security Code*:

Visa

MasterCard

American Express

Discover

* Information is submitted on a secure site however you may contact Beth Charles at 800.527.1155 ext 132
to finalize arrangements.

By checking this box I understand that a FIG representative will make travel arrangements on my behalf. The airline ticket will be charged to the credit
card provided. For qualified participants, FIG will
reimburse a predetermined amount based on qualifications. Call your marketer today for more information. By allowing us to book your travel arrangements, we will make every effort to accommodate your preferences, however FIG cannot guarantee that all requests will be honored due to availability. I also understand should I not be able to attend the meeting once flight arrangements are made, FIG is not obligated to reimburse me for the
cost of the flight.