Sample NAIC Registration and Payment Form
First Name
Last Name
E-Mail Address
Phone
District	Select District Carolinas Florida Georgia MD/DC/DE New England North Central Philadelphia South Central Virginia Western States
Local Church	Select Local Church Select District First
Package Selection
Diversity Package (All Inclusive) Includes: Conference Fee, Conference Support, Conference Memorabilia, Transportation to and from all Conference Events, Weekday Breakfast, Lunch, & Dinner at the Desmond Hotel, Saturday Breakfast at the Desmond Hotel, Saturday Night Event with Dinner. 1/19/2025 (Early Bird) 2/16/2025 (10% increase) After 2/16/2025 (15% increase) $730.00 $803.00 $839.50
Inclusion Package (No Saturday Event) Includes: Conference Fee, Conference Support, Conference Memorabilia, Transportation to and from all Conference Events, Weekday Breakfast, Lunch, & Dinner at the Desmond Hotel, Saturday Breakfast at the Desmond Hotel. 1/19/2025 (Early Bird) 2/16/2025 (10% increase) After 2/16/2025 (15% increase) $632.00 $695.20 $726.80
Value Package (Choice of 2 Weekdays) Includes: Conference Fee, Conference Support, Conference Memorabilia, Transportation to and from all Conference Events, Breakfast, Lunch, & Dinner at the Desmond Hotel, Saturday Breakfast at the Desmond Hotel, Saturday Event with Dinner. Choice of 2 days only. 1/19/2025 (Early Bird) 2/16/2025 (10% increase) After 2/16/2025 (15% increase) $484.00 $532.00 $556.60
Not Selecting a Package
A La Carte Breakfast ($20) Lunch ($30) Dinner ($40) Monday Activity with Lunch ($60) Tuesday Activity with Lunch ($60) Wednesday Activity with Lunch ($60) Thursday Activity with Lunch ($60) Friday Activity with Lunch ($60) Saturday Event with Dinner ($130 - Diamonds and Pearls Banquet) Memorabilia ($25) Conference support ($25) Conference Fee ($150) A La Carte Total Contribution Amount: $ What weekday will you need transportation from The "Square" to and from the Host Hotel?
Please select at least one checkbox.