Welcome to the
2018 Annual Convention
Registration Form

Location:
Guest House at Graceland
Memphis,TN
June 28-29, 2018
(Optional events on June 27th)
Register!
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What's your first name? [Primary attendee] *

 
Thanks, {{answer_Z64ArZq7lSoF}}. What's your last name? *

 
Do you have any industry designations?

 
What name or nickname do you want on your badge?

 
With what agency are you associated? *

 
Are you a current active Member of the PIA of TN? *

     
 
Would you like to activate your PIA membership and save $50 on your convention registration?

     
 
Are you registering for a Full Registration or Single Day pass? (check one)


 
Do you want to upgrade your Single Day Pass to a Full Convention Registration for only $50?

     
 
What day are planning to attend?


 
Here is the current Thursday, June 28th schedule. Please check all that you plan on attending.


 
Here is a current schedule for Friday, June 29th. Please select all that you plan to attend.


 
Here is the current schedule for Wednesday, June 27th. Please check all events that you plan on attending.


 
Here is the current Thursday, June 28th schedule. Please check all that you plan on attending.

Please only make one selection per time slot.

 
Here is a current schedule for Friday, June 29th. Please select all that you plan to attend.

Please only make one selection per time slot. Please only make one dinner selection.

 
While we cannot guarantee pairings, is there a specific team, company or player(s) you prefer to play with?

 
Would you like to purchase a foursome for the golf tournament and save an extra $20?

     
 
Who are the other three players on your team? (include yourself in the list)

 
What is the street address you want listed in the materials?

 
City?

 
State?

 
Zip?

 
What's your office phone number?

 
What is your cell phone number? *

 
Based on your previous choices, what is your arrival date? *

 
What is your departure date? *

 
Will your spouse be attending? [NOTE: If your spouse is an agent or staff, please choose "NO" and register them as an additional attendee. We will honor the spouse price, as an adjustment to the fee. Contact the PIA office before completing the registration for discount code.]

     
 
What is your spouse's first name?

 
What is your spouse's last name?

 
How would your guest like their name to appear on their badge?

 
What is your guests cell phone number?

 
Here is the current schedule for Wednesday, June 27th. Please check all events that your guest plans on attending.


 
Here is the current schedule for Thursday, June 28th. Please check all that your guest plans on attending.

Please only make one selection per time slot.

 
Here is a current schedule for Friday, June 29th. Please select all that your guest plans to attend.

Please only make one selection per time slot. Please only make one dinner selection.

 
Will anyone else be attending from your Agency or family who needs to be registered?

If your answer is 'yes' then please complete the following questions with their information.
     
 
Is this person attending the entire convention or just a single day? (check one)


 
Which day are they planning to attend?


 
Here is the current schedule for Thursday, June 28th. Please check all that this person plans on attending.


 
Here is the current schedule for Friday, June 29th. Please check all that this person plans on attending.


 
Here is the current schedule for Wednesday, June 27th. Please check all events that this person plans on attending.


 
Here is the current schedule for Thursday, June 28th. Please check all that this person plans on attending.

Please only make one selection per time slot.

 
Here is a current schedule for Friday, June 29th. Please select all that this person plans to attend.

Please only make one selection per time slot. Please only make one dinner selection.

 
What is this attendee's first name?

 
What's is this attendee's last name?

 
How would you like their name to appear on their badge?

 
What is their cell phone number? *

 
Based on your previous choices, what is this person's arrival date? *

 
What is their departure date? *

 
Will anyone else be attending from your Agency or family who needs to be registered?

If your answer is 'yes' then please complete the following questions with their information.
     
 
Is this person attended the whole convention or just a single day? (check one)


 
Which day are they planning to attend?


 
Here is the current schedule for Thursday, June 28th. Please check all that this person plans on attending.


 
Here is a current schedule for Friday, June 29th. Please select all that this person plans to attend.


 
Here is the current schedule for Wednesday, June 27th. Please check all events that this person plans on attending.


 
Here is the current schedule for Thursday, June 28th. Please check all that this person plans on attending.

Please only make one selection per time slot.

 
Here is a current schedule for Friday, June 29th. Please select all that this person plans to attend.

Please only make one selection per time slot. Please only make one dinner selection.

 
What this attendee's first name?

 
What's this attendee's last name?

 
How would you like their name to appear on their badge?

 
What is their cell phone number? *

 
Based on your previous choices, what is this person's arrival date? *

 
What is their departure date? *

 
Will anyone else be attending from your Agency or family who needs to be registered?

     
 
How many additional Full Registrations will your group need (Price=$150)?

 
How many additional Single Day Registrations will your group need (Price=$100)?

 
How many additional Presidents' Dinner tickets will your group need (Price=$85)?

 
How many additional Golf Registrations will your group need (Price=$60)?

 
If you received a VIP PROMO CODE, enter it Below! Otherwise, SCROLL DOWN to see your Registration Total.

 
Your total is {{var_price}}. Would you like to pay online or with a check?


 
Your current charge for the convention based on what you have entered above is {{var_price}}.


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Thank you for registering for the
PIA of TN Annual 2018 Convention.
We have your submission.

You should receive an email confirmation which includes details of this registration. If not, please contact the PIA office at (615) 771-1177.

To reserve your hotel room at The GuestHouse at Graceland, Click Below
RESERVE YOUR ROOM
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