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2. personal finance
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ICBA COMMUNITY BANKING LIVE® 2015
March 1-5, Gaylord Palms Resort & Convention Center, Orlando, Florida
TO REGISTER
REGISTRATION INFORMATION
Check one:  Member  Non-member
Check one:  Mr  Mrs  Ms
 First-time Attendee
# of ICBA Conventions attended
ONLINE
www.icba.org/convention2015
Name (as you want name to appear on badge)
FAX
Bank/Company
Title
320-352-5567
MAIL
ICBA
Attn: Convention Registrar
518 Lincoln Road/P.O. Box 267
Sauk Centre, MN 56378
MULTIPLE
DISCOUNT**
Address
City/State/Zip
Phone
Fax
Email Address (Email will be used for banquet seating notice)
Spouse/Guest*
*A guest is a spouse, significant other, or friend who is not in a financial occupation. A co-worker or an associate with financial services industry may not
be considered a guest. Only registered guests will be allowed access to all convention activities and the Exhibit Hall.
The multiple discount applies to
main registrants from the same
institution after the first fully paid
registrant has registered. Multiple
registrations must be submitted
together for the discount, one
main registrant per form.
Child’s Name
SPECIAL NEEDS
ICBA Member (first paid registrant)
$1,095
$1,395
ICBA Member Multiple Discount**
$995
$1,295
Spouse/Guest*
$495
$595
Student (post secondary)
$225
$235
Child (5–18 years)
$150
$160
$1,595
$1,895
 If you have special needs that
may affect your participation in
this event, please check here. We
will contact you to discuss.
REGISTRATION LIST
You must register by February 10,
2015 to be included on the final
Convention Registration Listing
distributed at convention.
 Check here if you do not want
your name to appear on the web
site or final registration listiings.
CANCELLATION
Cancellation must be received
in writing by February 10 for a
full refund, less a $50 per person
processing fee; 50% refund if
received before Feb. 28. No refunds
given after Feb. 28. A substitute
registration will be accepted.
Check one: Male Female
REGISTRATION FEES
Child’s Name
Age
Early-bird
saves
$300!
EARLY BIRD
PRICE
(Per Person)
Non-Member
AFTER JAN.
FEB. 19
6
AFTER
(Per Person)
Age
Check one: Male Female
Age
FEES ENCLOSED
EARLY-BIRD DEADLINE
EXTENDED TO FEB.6
SPECIAL OFFER—SAVE $500
$500 of the non-member registration fee may be applied to bank’s membership in ICBA, contact [email protected] for details.
BANK DIRECTOR CURRENT ISSUES —Sunday, March 1
Banks enrolled in ICBA Bank Director Program
$99
$149
Banks NOT enrolled in ICBA Bank Director Program
$149
$199
CEO COMPLIANCE REVIEW SEMINAR—Sunday, March 1
ICBA Member
Nonmember
$99
$149
$149
$199
$
TOTAL
**For each additional person from the same institution registering at the same time.
GIVE KIDS THE WORLD—Saturday, February 28—1:30p.m. - 4:30p.m.
(must be at least 12 years old, space is limited)
Attendance at all ICBA programs
will be considered on a first come,
first served basis. If the program
is cancelled, ICBA’s liability is
limited to the registration fee.
Name(s)
QUESTIONS?
 Mastercard  Visa  American Express  Discover
For further information, call
1-866-843-4222 or email us at
[email protected]
Child’s Name
Check one: Male Female
Number of Helpers
CONVENTION PAYMENT SECTION
 Bill Me Later. (Register today and pay before January 19, 2015 for early bird pricing.)
Card Holder Name
Credit Card Number
Expiration Date
Card Holder Signature
Amount $
Register online at www.icba.org/convention2015 | Questions, call 866-843-4222
CID# (This is the 3 or 4 digit
security number on your card)