Las Vegas
Arpin Sales Association Meeting
Registration Form

Rio All-Suite Hotel & Casino
Las Vegas, Nevada

Tuesday, April 15th

Registration Fee is $50.00 per person.

If you prefer to fax (401-823-5540) your registration form(s), please click here to download the registration packet.

All registrations are automatically charged to your agency account following the meeting.
If you would like to pay the registration fee with Arpin Dollars, please mail the Arpin Dollars to Kathy Frazier's attention at the corporate office prior to the meeting
(note: Arpin Dollars may be used for the registration fees only).

Las Vegas ASA Meeting Registration Deadline - March 1st
We have a limited number of rooms at the Rio All-Suite Hotel & Casino at our special regional meeting rate of $160.00/night single or double occupancy. $30.00/person for third & fourth person in same room (maximum 4 people per room). Hotel registrations are available on a first come, first served basis only so early registration is strongly advised.

.CANCELLATION POLICY: All cancellations must be received by e-mail (kfrazier@arpin.com) or fax (401-823-5540) no later than March 1st. Cancellations received after March 1st will be subject to a cancellation fee of 100% of the regular registration fee (or $50.00/person).

Las Vegas ASA Registration Information

Agency Name (required):

Email Address (required):
Agency Account Number:

Phone Number:

Please list the first and last names of all attendees. For each individual, also specify whether they intend to sit for the **CMC exam:

**Note: To sit for the CMC exam, you must have applied for and received your certification study materials from the AMSA. For more information, refer to the AMSA website
or click below to download the
CMC application.

Attendee #1: Sit for CMC?:

Attendee #2: Sit for CMC?:

Attendee #3: Sit for CMC?:

Attendee #4: Sit for CMC?:

Hotel Room #1

Name(s)
Check In Date
Check Out Date

Credit Card
Information

 Type:   
Card Number:   
Expiration Date (MM/YY):
Card Holder Name
Card Holder Phone Number
Additional Requirements
Non-Smoking       Smoking          
Other. Please Specify:

Hotel Room #2
Name(s)
Check In Date
Check Out Date
Credit Card
Information
Type:   
Card Number:   
Expiration Date (MM/YY):
Card Holder Name
Card Holder Phone Number
Additional Requirements

Non-Smoking       Smoking     
Other. Please Specify:


Hotel Room #3
Name
Check In Date
Check Out Date
Credit Card
Information
Type:   
Card Number:   
Expiration Date (MM/YY):
Card Holder Name
Card Holder Phone Number
Additional Requirements
Non-Smoking       Smoking          
Other. Please Specify: