2024 TMPAA Mid-Year Meeting May 13-15, 2024 | Marriott Water Street | Tampa, FL NOTE: Registration fee increases to $1,200 for members after May 3, 2024. Registration Details First Name * Name as you want it to appear on your name tag. Last Name * Company/Agency Name * Company/Agency Address * City * Country * - select Country - United States American Samoa Bermuda Canada Germany Ireland Israel Mexico United Kingdom United States Minor Outlying Islands State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Phone * Mobile Phone Mobile numbers will appear in the printed attendee list and the mobile app to help other attendees reach you during the event. Email Address * Position * Membership * Program AdministratorCarrier (membership required to attend)Service Provider (membership required to attend) List up to three programs you currently administer This will be used in the attendee list. 50 character limit. Service Provider Category (select one) - select Service Provider Category (select one) - Actuarial Services Back-office/Underwriting Outsourcing Capital Provider Claims Management Client/Policy Management Technology Data Solutions Financial Services M&A Advisory Program/Product Development Rating and Issuing Technology Regulatory Compliance/Licensing Reinsurance Intermediary Risk Management/Risk Control Business Consulting/Marketing Technology – Other Talent/Staffing/Personnel This will be used in the attendee list Program Appetite/Services Needed This will be used in the attendee list. 50 character limit. Event Fee(s) If you have a discount code, enter it here Apply Conference Fee * Members - $ 995.00 Non-Members - $ 1,195.00: Restricted to eligible program administrators TMPAA Charities Donation * $50 $100 $250 $500 Other None Other Donation Amount Total Authorize.net (Credit Card) Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 My billing address is the same as above Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States American Samoa Bermuda Canada Germany Ireland Israel Mexico United Kingdom United States Minor Outlying Islands State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Review