NAMIC Events and Seminars | Optional Activity/Guest Additions Form

<< Return to NAMIC Events

This form is not used to register for an event. Please go back to the event page and complete the full registration form.

To add a guest registration or optional activity to an existing registration please complete the form below. NAMIC will verify the cost and additions request before charging the credit card. An updated copy of the confirmation email will be sent once the addition has been made. Click Summary/Receipt in that email to view an updated registration receipt.

Attendee Information

* First Name

* Last Name

* Company / Affiliation

* Telephone

E-mail Address

Confirmation Number
(if known)

* Event Attending

* Additions to existing registration
(please enter which activity and the cost)

Payment Information

* Credit Card Type

* Card Number

* Expiration Date

* Cardholder Name

Wildcard SSL

NAMIC Online is protected by DigiCert.

317.875.5250 - Indianapolis  |  202.628.1558 - Washington, D.C.

NAMIC | Where the future of insurance has its voice TM