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On-Line Badge Registration


Note: This form is to be filled out by EXHIBITORS ONLY

(Convention Home)

Items marked with an * are required.

Company Name:*
Address:*
Phone:*
Fax:
Email Address:*
Company Name For Badge:






Name Fully registered for Convention? City
* * *




Questions or Comments?
Contact Fred Phelps
Director of Sales & Marketing
FAIA
PO Box 12129
Tallahassee, FL 32317-2129
Phone: (850) 893-4155 ext. 342
Fax: (850) 668-2852
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Mission Statement:  To serve Florida insurance agents by promoting a healthy and competitive insurance environment.

3159 Shamrock South * P.O. Box 12129 * Tallahassee, FL 32317-2129 * Tel: 850.893.4155 * Fax: 850.668.2852
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