RESERVATION FORM

“MAXIMIZING THE SENIOR

MARKET” TRAINING CAMP

APRIL 22-23, 2010

AMERISTAR CASINO HOTEL

COUNCIL BLUFFS, IA 51501** (OMAHA METRO AREA)

Limited Seating ~ Please Act Now!

Yes…please reserve* a seat for me at the “Maximizing the Senior Market” Training
Camp.
NAME: _______________________________________________________________________________

ADDRESS: ____________________________________________________________________________

CITY: ______________________________________________ ST: _____________ ZIP: _____________

PHONE: ______________________________________________________________________________

EMAIL: _______________________________________________________________________________

SIGNATURE: ___________________________________________________________________________

Agent is responsible for all travel and hotel room accomodations.

Up to 18 Hours of FREE CE (varies by state). Voucher to all attendees who attend all sessions)
$99.00 deposit required to reserve seat (returned upon training camp check-in).
This registration form and check must be submitted by Friday, April 2, 2010.
Check payable to Premier Insurance Partners.
Mail check and this form to:

Premier Insurance Partners; 1015 N. 204th Avenue; Omaha, NE 68022

800-504-7471 * www.pip1.com
We look forward to seeing you at our training camp!

**Call 877-462-7827 for Ameristar Hotel room reservations**