Kansas Association of Insurance Agents
Kansas Association of Insurance Agents
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2011 Young Agents Conference  

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If you are a member but do not know your login click on the “Forgot username or password?” option to get your login credentials. Once logged in, the data entry fields below will be pre-filled in with your information. In addition, you will automatically receive member pricing and access to member only items that may be available. Log in using the MEMBER LOGIN fields above..
* First Name
* Last Name
* Email
* Address Line 1
* City
* State
* Zip
Spouse Name
Child(ren's) Name(s)
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I agree that by registering for this Event, I will allow the information that I have provided in this registration form (excluding financial and disability information) as well as my image or likeness to be reproduced by IIABA or the sponsoring state association ("Sponsor") in any media, including, for example, electronic or print form, for use on web sites, or in any other publications, promotions, or presentations created by the Sponsor, in the Sponsor's sole discretion.

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