When

Friday, January 10, 2020 at 1:00 PM EST
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Where

Port of Miami - Symphony of the Seas

1015 N. America Way
Miami, FL 33132

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Contact

Becky Cotner
Diversified Crop Insurance Services
618-263-2767
becky.cotner@cgb.com

2020 Diversified Crop Insurance Services Risk Management Conference - Caribbean Cruise

Please type all information carefully as the information that you provide will be used for everything from booking airline tickets to on-site name badges. Should you have any questions while filling out this form, please contact Becky Cotner at (618) 263-2767 or becky.cotner@cgb.com or Tonya Nielsen at (651) 354-1668 or standoutevent@outlook.com.

* Required information

  • Please be sure to complete your registration by Wednesday, October 16, 2019. Should you have any questions while filling out this form, please contact Becky Cotner at (618) 263-2767 or Tonya Nielsen at (651) 354-1668. Upon completion of this registration site, the credit card that you provide will be charged at this time.

Personal Information (LEGAL NAME, PLEASE)

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  • Fee

    Type Fee
    $2,150.00
    $3,800.00
    $2,025.00
    $1,900.00

Emergency Contact Information

  • Emergency Contact Information should be someone who is not traveling with you on this trip.

  • REFERRING AGENT

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  • Do you agree to have your home address listed on the attendee list? (*Note - DCIS will not give out your address to anyone but those attending the cruise.)

Airfare Request

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    Would you like to request a quote on Airfare to Miami by our flight specialist?

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  • After you complete the register for this trip, a travel specialist will contact you within a couple of days with flight options and costs.

Passport and Special Requests

  • All travelers will be required to provide a valid government-issued passport when checking in at the airport. If you do not have a passport or if you need to renew your passport, please visit the appropriate website ASAP to learn how to obtain one. Application processing time for a new or renewed passport can take several weeks, so do not delay in taking steps to obtain one. Please note, all existing passports must be valid for up to 6 months beyond your scheduled return date. If your current passport is not valid through July 1, 2020, you MUST renew your passport prior to traveling on the cruise. If you do not know your current passport information, please leave the below information blank. Once you have your passport information, please contact Becky Cotner or Tonya Nielsen.

  • Passport Information

  • Special Requests

  • Do you have any medical conditions or physical needs that we need to be aware of?

  • I hereby consent and agree that DCIS, its employees, or agents have the right to take photographs, videos or digital recordings of myself and my guests beginning on January 10, 2020 and ending on January 18, 2020 while on the cruise and to use these in any and all media now or hereafter known.

  • I further consent that our names and identity may be revealed therein or by descriptive text or commentary.

Guest Information

You may add a maximum of 3

$9,999.99

Payment

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