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Tickets to Reserve(Required)

9:00-12:00 Delivering Quality Service (3 hours AM/ KS / General credit in MO) KS#972190IAM

1:00-3:00 Ethical Insurance (2 hours Ethics) KS#967655ETH

BOTH 9:00-12:00 Delivering Quality Service (3 hours AM/ KS / General credit in MO) KS#972190IAM 1:00-3:00 Ethical Insurance (2 hours Ethics) KS#967655ETH

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First And Last Name As Listed On Insurance License(Required)

First Last

First And Last Name for Name Tag(Required)

First Name Last Name

Agents First And Last Name (if different)

First Name Last Name

Agency Name(Required)

NPN Number (NOT your SSN#)(Required)

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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Will you be attending lunch?(Required)

Catered by Minsky’s Pizza

Yes

Are you attending with anyone from your office?(Required)

Yes

Attending guest name (If any)

Thursday, 11/16/2023 PowerDry CLASSROOM

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