SALGBA 2012 Agenda Overview

PAGE 2
HYATT REGENCY
SAN FRANCISCO AIRPORT
SPECIAL
POINTS OF
INTEREST:

3 0 T H
Timely
Certification
credit

Outstanding
networking
opportunities

Unique
Tuesday Night
Event

Golf Tournament at Championship Course

A N N U A L
C O N F E R E N C E
A P R I L
1 5 - 1 8 ,
2 0 1 2
Invitation from SALGBA Leadership
education

SALGBA 2012 Annual Conference
Sunday Tour
INSIDE THIS
ISSUE:
Networking
Events
3
Agenda at a
Glance
4-6
2013 Conference
Information
8
Venue
Information
19
Disclaimers
10
Registration
Information
11
CGBA
Application
13
Registration
Forms
14
The SALGBA Board of
Directors and National Office
invite you to join us as we
“Hop on Board” with colleagues
and industry experts in San
Francisco for the SALGBA 30th
Annual Conference. SALGBA
is excited to offer another
outstanding educational and
networking opportunity to
SALGBA members, public
sector benefits professionals and
industry associates.
The SALGBA 30th Annual
Conference in San Francisco
will offer 32 educational
sessions which can qualify for
up to 22 CGBA educational
credits. In addition to the timely
education, attendees will also
have opportunities to network
with peers at various functions.
From the Sunday Golf
Tournament or Sunday Tour to
The premier organization
for public sector benefits
professionals...
the Tuesday Night visit to the
Aquarium there are plenty of
opportunities to network and
talk shop with your peers and
colleagues. The advantages of
attending are immense and for
the small monetary investment
there is not a better bang for
your buck than SALGBA!
This is the perfect
opportunity to get up to date
information on Federal Health
Care Reform and how to best
prepare for the many changes.
We are also pleased to have
keynote presentations by Dr.
Rob Epstein with Medco and
Mark Funkhouser with
UnitedHealth Group along with
many state and local
administrator presentations.
So “hop on board” with
SALGBA!
Who Should Attend?
The State & Local Government
Benefits Association was started in
1982 by a group of state and local
benefits administrators who realized
the specialized need they had in
obtaining education and information
about the benefits industry as it
related to the public sector.
SALGBA conferences have seen
a rapid growth since 2005 as issues
with public sector healthcare have
grown more prominent. SALGBA
conferences have grown from 225
attendees to about 450
attendees over the past 4 years and
with healthcare reform upon us we
expect that number to continue to
grow. So if you are a benefits
administrator, executive director,
benefits manager or human
resource professional of a public
sector entity with benefits as a part
of your job duties you should
definitely attend.
If you are an industry associate
who offers a service to the
benefits industry and would like
to be in front of the government
sector decision makers then you
should also attend and consider
exhibiting as a way to network
with attendees.
PAGE
Golf Tournament
3
SALGBA 2012Golf
Tournament
proudly sponsored
by Medco
This year’s golf tournament
is being held at TPC Harding
Park which is one best golf
courses in the area.
TPC Harding Park was
renovated in 2004 and its
restoration has been a
continuing focus of golf
industry attention, making
Harding one of the great public
golf experiences in the US. The
improvements were completed
on the basis of returning PGA
Tour events to its storied
grounds. As a result, Harding
has played host to the 2005
World Golf Championship, the
Presidents Cup 2009, and most
recently Charles Schwab Cup
Championship in November of
2010 and the Charles Schwab
Cup Championship in
November 2011.
Clubs can be rented by
contacting the course directly.
Club rentals are $50 and all
rental sets are Titleist, Nike,
Callaway, and Taylor Made;
all rentals include a package of
6 golf balls and a bag of tees.
In order to participate in the
golf tournament you must
register online or on the
registration form located in
this brochure and make
payment in full by March 30th.
You must also include your
golf handicap which will be
used in forming teams.
Please be as accurate as
possible!
The tournament is rain or
shine and no refunds will be
issued after March 30th.
Proper golf attire is required.
Sponsored by:
Sunday Tour
The Sunday Tour “Highlights
of San Francisco” is proudly
sponsored by Fringe Benefits
Management Company, a
Division of WageWorks
The 2012 Tour of San
Francisco, proudly sponsored
by Fringe Benefits Management
Company, a Division of WageWorks
will feature many of the
famous landmarks and
highlights of San Francisco,
including Fisherman’s Wharf,
Chinatown, North Beach,
Union Square, Golden Gate
Bridge, Presidio, Golden
Gate Park, HaightAshbury, Twin Peaks,
Civic Center and other
areas.
The group will be taken to
the waterfront where they will
board the ferry to the most
famous of California's islands:
Alcatraz (“The Rock") where
the group will be able to enjoy
the self-guided audio tour of
the infamous cell house. After
returning from Alcatraz, the
group will re-board the coach
for a trip to the Golden Gate
Bridge.
The tour will begin at
8:30am and return to the hotel
at 3pm allowing attendees
time to relax before attending
the Opening Night Reception.
We hope you will join us
for this exciting trip sponsored
by Fringe Benefits
Management Company, A
Division of WageWorks.
Tuesday Night Event
The 2012 Tuesday Night Event
will be held at the Aquarium of
the Bay which is San Francisco
Bay’s Aquarium located at the
heart of San Francisco's history
and culture. We are nestled in
the shadow of Coit Tower and
Telegraph Hill on Fisherman’s
Wharf at PIER 39, along the
City’s “Walkable Waterfront.”
SALGBA
2012
ANNUAL
Attendees will depart the
11:00pm so you have time to exHyatt Regency SFO at 5:30pm for plore more of PIER 39.
an entertaining trip to PIER 39
The 2011 Tuesday Night Event is
and the Aquarium. Attendees will sponsored by:
have full access to the Aquarium
with food and beverage. The
event will conclude at 8:30pm but
the evening does not have to end
as transportation will be available
for return to the Hyatt until
SALGBA 2012 Agenda Overview
PAGE
4
Saturday, April 14, 2012
12:00pm3:00pm Board Meeting
3:30pm5:30pm Registration Open
Sunday, April 15, 2012
9:00am2:00pm SALGBA Golf Tournament at TPC Harding Park sponsored by Medco
12:00pm6:00pm Registration Opens
8:30am- SALGBA Tour of San Francisco and Alcatraz sponsored by Fringe Benefits Management Company, a division of
4:00pm WageWorks
6:00pm8:00pm SALGBA Opening Night Networking Reception in Exhibit Hall
Monday, April 16, 2012
7:30am4:00pm Registration Open
7:00am8:00am
Continental Breakfast in Exhibit Hall
8:15am8:30am Welcome
Welcome by Pete Hans, SALGBA President
8:30am9:30am Opening Keynote Dr. Rob Epstein, Medco
9:30am10:00am
Break in Exhibit Hall
10:00am- Breakout
11:00am Sessions
What's Next for
Healthcare Reform:
The Next Generation of
Looking Into State and Advanced Applications Consumerism--Clinical
Private Health Insur- of Behavioral Science Solutions to Manage
ance Exchanges
to Pharmacy Benefits Costs
The Stars are Aligned:
A Collaborative Approach to Creating a
Sustainable Medicare
Advantage Solution
Rick Johnson, The
Segal Company
Dave Burianek,
Humana
Anne Jones, Humana
11:15am- Breakout
12:15am Sessions
Mark Bini, Express
Scripts
Dr. Brian Kelly, Aetna
What are State and
Local Governments
Regulatory Roundup: Doing to Manage The The Choice is Yours: UtilIt's Getting More and Cost of Their Health izing Technology to Sim- Update on GASB
More Complicated
Plans
plify Benefits Planning
Exposure Draft
Jody L. Dietel, Wage- Bob Cosway, Milliman, Patrick Stroh, Prescription Paul Angelo, The
Works
Inc.
Solutions
Segal Company
12;15pm
1:30pm
Lunch with Jeff Havens (Grand Ballroom)
PAGE
5
1:45pm
Breakout
2:45pm Sessions
SALGBA 2012 Agenda Overview
Strategies for Optimal Health and
Pension Plan Integration with Medicare and Social
Security During
Retirement
Uncertain Times Session TBD
Workplace Possibilities:Improving
Employee Productivity in the
Public Sector
Workplace
Detecting and Reducing Waste and Taking Control of
Fraud in Health- Your Pharmacy
care
Benefit Destiny
Pam Palmquist,
MOSERS
Jean MacQuarrie, Lisa Ellinger, State of Carole Porambo,
Thomson Reuters Wisconsin
SSDC
TBA
Michael KlachefBrent Eberle, Navitus Kristin Tapley,
sky, The Standard State of Maryland Health Solutions
Transition Assist
Jim Ramnaraine,
Hennepin County,
MN
Auburn University
2:45pm
3:15pm
3:15pm
4:30pm Roundtables
Break in Exhibit
Hall
Local Entities
State Entities
4:30pm
5:15pm Sponsor Reception (By Invitation Only)
Tuesday, April 17,
2012
7:30am
4:00pm Registration Open
8:00am
Continental Breakfast in Exhibit Hall
8:30am
8:30am
Tuesday
How Do YOU Change Government--Dr. Richard Migliori, Chief Healthcare Officer, UnitedHealth
9:30am Keynote
Group Alliance and Dr. Mark Funkhouser, Director of Governing Institute
9:45am
10:45a Breakout
m
Sessions
Achieving Measurable Improvements in Employee Health
Risk
Fire Your COBRA
TPA: How To
Bring Your COPharmacy Trend;
BRA Administra- Predictors and Foretion In-House
casting
How the State of
Nevada and its
Medicare Retirees
Both Came Out
Ahead
R. Keith Cox, Alabama State Em- Abbey Hendricks,
ployees' InsurMultnomah
Anita Allemand, CVS Dick Wheeler,
ance Board
County, OR
Caremark
Extend Health
Anna Theodorou,
CVS Caremark
Jim Wells, Nevada
Public Employees'
Benefits Program
PAGE
6
SALGBA 2012 Agenda Overview
10:45am11:15am
Break in Exhibit Hall
11:15am- Breakout
12:15pm Sessions
Intersection Between State Mandates and Essential
Health Benefits:
Integrating EmHow the California
ployee Wellness Health Benefits Re- Speciality Therapies
with your Medical view Program Could Gushing Through
Plan
Serve as a Model Pharma Pipeline
Panel--Garen
Mark Washington, Corbett,
City of Austin, TX Moderator
Why Public Sector
is Looking at
Medical Travel to
Lower Healthcare Communicating
Costs and GASB Pension Benefits
45 Liabilities
to Employees
Steven Lash,
Michael Huffer, CVS Satori World
Caremark
Medical
Panelists: Edward
Dr. Ron Johnson,
Karen Haywood, Yelin, Todd Gilmer Jennifer Flory, State Satori World
City of Austin, TX & Dominique Ritley of Kansas
Medical
12:30pm1:30pm
1:45pm3:00pm
Awards Luncheon
Improving Patient
The Tennessee
Compliance Through
Partnershp Plan: Eliminating Waste-- Disease Therapy
Engaging Employ- Continuous Monitor- Management ProBreakout Ses- ees Through
ing/Auditing of Ven- grams--Changing
sions
Benefit Design
dors
Role of PBM's
Laurie Lee,
Kendra Gipson &
Paige Turner-State of Tennessee, Dept. of Finance & Admini- Anne Timmons,
stration
State of Maryland
3:00pm3:45pm
3:45pm5:00pm
R.J. Correia, Prescription Solutions
The Unintended
Consequenses of
Change: Developing a Holistic
Strategy for Pre
and Post 65 Retiree Healthcare
Dan Cahill, Buck
Consultants
Break in Exhibit Hall--Door Prize Drawing (must be present to win)
Interactive
Wellness
Sessions
Group Walk
(Meet in Hotel
Lobby)
Group Run
(Meet in Hotel
Lobby)
What's Next for
Healthcare Reform:
Looking Into State
and Private Health
Insurance Exchanges
Rick Johnson, The
Segal Company
Jen Schuster, The
Segal Company
30TH
ANNUAL
PAGE
7
SALGBA 2012 Agenda Overview
SALGBA Tuesday Evening Event at the Aquarium by the Bay in downtown San Francisco sponsored by Active6:00pm- Health Management--transportation will be provided with return service from the downtown area until 11pm-8:30pm details to follow.
Wednesday, April 18,
2012
8:30am9:30am
SALGBA Jurisdictional Members Business Meeting/Breakfast
9:45am11:00am
Managing the Healthcare Dollar in a Time
of Budget Constraints
Value-Based Insur- and an Evolving
ance Design: A Case Healthcare LandStudy
scape
Successful Immunization
Strategies: Using an Evidence Based Model to
Estimate Cost Effectiveness
Susan Smith, TML
Bimal Patel, MedIm- Intergovernmental
pact Healthcare
Employee Benefits
Systems, Inc.
Pool
Michael S. Taitel,
Walgreens
Adjourn & Grand Prize Drawing to Jurisdictional Attendee for $1000 to attend 2013 SALGBA Conference April
28-May 1 in San Antonio, TX and Grand Prize Drawing to Associate Attendee for complimentary booth space at
11:00am the 2013 SALGBA Conference in San Antonio, TX. (Must be present to win!)
2012 Scholarships are available for Jurisdictional Attendees.
To apply please go to www.salgba.com to download an
application.
Applications are due by February 15, 2012.
Recipients will be notified by March 15, 2012
Page 8
SALGBA
State & Local Government
Benefits Association
SALGBA
PO Box 867
Berea, KY 40403
Phone: 888-623-8676
To view additional conference
information or to register to
attend the conference whether
paying online or by check please
go to www.salgba.com.
Fax: 859-623-8694
E-mail: [email protected]
The premier organization for public
sector benefits professionals.
www.salgba.com
Mark your calendars for SALGBA 2013
The SALGBA 2013 Annual Conference will be held at
the Hyatt Regency Hill Country in San Antonio, TX. Mark
your calendars for April 28-May 1, 2013 to join colleagues
for a superior educational and networking conference
where your return on investment is unmatched!
For your budget preparations, the negotiated room rate
for jurisdictional attendees is $129 and for associate
attendees the negotiated rate is $179 both are per night plus
tax.
The Hyatt Regency Hill Country is a beautiful location
with the perfect layout for a SALGBA conference. In
addition, we are fortunate to have local hosts in the area to
assist with planning. We hope you will mark your
calendars!
Picture of Hyatt Regency Hill
Country
PAGE
9
Hyatt Regency SFO
1333 Bayshore Hwy
Burlingame, CA
940101
Phone: 650-347-1234
Conference Venue/Accommodations
No need to trade comfort for
convenience when you can
have both at Hyatt Regency
San Francisco Airport.
Experience our ideal location
on San Francisco Bay - just
15 minutes from downtown
San Francisco, or the
technology corridor of
Silicon Valley - and only
seven minutes from San
Francisco International
Airport.
Recently updated, our
sophisticated hotel near San
Francisco airport offers a
pampering array of amenities and
services with an emphasis on
sustainable and green practices.
Fly in and host highly successful
meetings in 52,000 square feet of
flexible function space offering
award-winning cuisine and the
level of hospitality you’ve come
to expect from Hyatt. Always
welcoming, stay with us and learn
the difference between a hotel and
a Hyatt.
All educational events and exhibit
functions will take place at the
Hyatt Regency SFO. A block of
rooms have been reserved and are
available on a limited basis.
The jurisdictional rate is $125
per night plus tax. There is a
group rate of $179 per night
plus tax for associate attendees.
To make reservations follow
the link below or call 650-3471234:
https://resweb.passkey.com/
Resweb.do?
mode=welcome_ei_new&eventI
D=3447312
Hyatt Regency SFO
1333 Bayshore Hwy
Burlingame, CA 94010
Transportation
San Francisco International
Airport (SFO), the “gateway to
the Pacific,” is a world-class
airport serving tens of millions
of domestic and international
passengers annually.
One of the world’s 30 busiest
airports, SFO is committed to
setting the standard for our
industry. This includes being a
leader in safety and security,
customer service and
satisfaction, community
relations, environmental
commitment, quality of facilities,
and financial and economic
vitality. SFO was the first major
U.S. airport to achieve 100
percent fully automated and
integrated baggage screening.
Today, efficient operations
ensure our passenger screening
wait times are among the
shortest in the nation.
There is complimentary
shuttle service between hotel
and airport. Follow exit to
hotel shuttle and look for
Hyatt/Marriott shuttle. It
runs approximately every 15
minutes.
For airport information please visit: http://www.flysfo.com/web/page/index.jsp
Area Activities
San Francisco
Convention
Visitors Bureau
www.sanfrancisco.
travel.
SALGBA
47 square miles. 43 hills.
145 languages. San
Francisco, more than any
other major American
city, is defined by its
neighborhoods.
2012
ANNUAL
For more information on
San Francisco please
visit
www.sanfrancisco.travel
PAGE
10
Session Material
The 2012 Annual
Meeting will
feature all handouts
on the SALGBA
website prior to the
meeting and will be
available for
attendees via the
website for 90 days
after the meeting.
No handouts will be
available onsite.
Handouts and other
conference material
will also be available
on a USB Drive
which will be given
to each conference
attendee.
If you have
questions or need
assistance in
regards to accessing
session or
conference material
please contact
SALGBA.
Views & Opinions
The views and
opinions expressed by
speakers are their own
and do not necessarily
represent those of
SALGBA. SALGBA
disclaims any
responsibility for
the use and application
of information
presented at this
meeting.
Disclaimer
By registering for this
conference you agree to
abide by the Policy and
Procedures as set out by
SALGBA in accordance
with the SALGBA
Constitution and By-laws.
This includes the right to
use any photographs taken
during SALGBA events for
use in marketing material, on
the website, or as otherwise
deemed to be used by
SALGBA and their
affiliates.
SALGBA
2012
ANNUAL
If SALGBA cannot hold
the 2012 Annual Meeting
due to acts of God, war,
government relations,
disaster, strikes, civil
disorder, or curtailment of
transportation facilitating
other emergencies making
it inadvisable, illegal or
impossible to provide the
facilities to hold the
meeting, each prepaid
attendee will receive a copy
of the conference handouts
and any other materials that
would have been
distributed. Fixed
conference expenses will be
paid from the
pre-registration funds.
Remaining funds will be
refunded to pre-registrants.
SALGBA is not responsible
for any other costs incurred
by pre-registrants in
connection with the
conference.
PAGE
11
Certified Government Benefits Administrator Program
SALGBA offers a certification
program. The program is
certified by an accredited
university which also offers
continuing education units for
SALGBA approved educational
events. The Certified
Government Benefits
Administrator (CGBA)
program is a program available
to SALGBA members who
enroll. Enrollment is a separate
process from membership and
credit is not received unless
enrolled in the program.
Certification must be obtained
within five years of joining and
can be done in as little as three
years. The requirements are
outlined in the CGBA
guidelines which can be found
at www.salgba.com under the
Professional Development link.
Education credits are easiest
to obtain by attending a
SALGBA regional or national
conference. There are also
some circumstances where
transfer credit will be
accepted.
Certification requires three
credit reports be on file and
reviewed (these are annual
report that are due by January
31st of each year) and a total of
81 credits. A minimum of 24
credits must be in
experience and a minimum of
42 credits must be in education.
If your employer requires a
certification then this program
is perfect for you. To enroll
complete the enclosed CGBA
application.
Registration Information
There are several options in
which to register for the
SALGBA conference.
vendors and suppliers.
*Both of these options also have
non-member rates
associated with them.
*Option 1:
Register as a jurisdictional
attendee which is an attendee
who is employed by a
government entity.
Option 3:
Register as a guest. A guest is a
spouse, significant other or
dependent that is traveling with
you. This is not to be used for
colleagues or co-workers.
*Option 2:
Register as an associate
attendee which is an attendee of
an entity that is not a
government entity. This is for
Registrations
received by
January 16,
2012 are
reduced by
$25.
Option 4:
Register as a student. This is
Option 5:
Register for a one-day pass to be
used either Monday or Tuesday
and does not include evening or
special events. This is available
only to jurisdictional attendees.
Sponsor and Exhibitor
registrations that are
complimentary based on support
are handled in a separate manner.
Registration Fees
Jurisdictional Attendees:
Associate Attendee:
Member
$300
Member
$500
Non-Member
$500
Non-Member
$700
Late Jurisdictional Attendees:
Late Associate Attendees:
Member
$400
Member
$600
Non-Member
$600
Non-Member
$800
Guest Attendee:
SALGBA
available for full time students
only and must be approved by
SALGBA.
2012
ANNUAL
$100
Student Attendee: $200
One Day Jurisdictional
Pass:
$99
Exhibitor Registration:
$350
PAGE
12
Board of Directors
OFFICERS
President
Pete Hans, CGBA
Waukesha County, WI
1320 Pewaukee Rd., Rm 160
Waukesha, WI 53188
[email protected]
President-Elect
Hubert Lincecum, CGBA
Office of Group Benefits, LA
7389 Florida Blvd., Ste. 400
Baton Rouge, LA 70806
[email protected]
Treasurer
Cindy Kirk, CGBA
City of Bryan, TX
300 S. Texas Ave., Ste. 213
Bryan, TX 77803
[email protected]
Mark Saiz, CGBA
City of Albuquerque, NM
One Civic Plaza, 7th Fl.
Albuquerque, NM 87103
[email protected]
Chuck Griffith, CGBA
Bernalillo County, NM
One Civic Plaza NW, 4th Floor
Albuquerque, NM 87102
[email protected]
Pam Stultz, CGBA
Larimer County, CO
2555 Midpoint Dr., Ste. A
Fort Collins, CO 80525
[email protected]
ASSOCIATE MEMBER
ADVISOR
Nicki Pfleider, CGBA
Jefferson County Public
Schools, KY
3332 Newburg Rd.
Louisville, KY 40218
[email protected]
hools.us
Vacant
DIRECTORS
PAST PRESIDENTS
Pam Palmquist, CGBA
MOSERS
PO Box 209
Jefferson City, MO 65109
[email protected]
Rick French, CGBA
City of Garland, TX
PO Box 460873
Garland, TX 75040
[email protected]
Scott Mixon, CGBA
Fringe Benefits Management Company, a Division of WageWorks
3101 Sessions Rd.
Tallahassee, FL 32303
[email protected]
Scott Gibbs
McGriff, Seibels & Williams
5080 Spectrum Dr., Ste. 900
Addison, TX 75001
[email protected]
Executive Director
Tina Bowling
SALGBA
PO Box 867
Berea, KY 40403
[email protected]
P: 888-623-8676
F: 859-623-8694
C: 859-358-3443
Conference Committee
Pam Palmquist, Co-Chair
MOSERS, Missouri State Employees
Retirement System
Pam Stultz, Co-Chair
Larimer County, CO
Ava Lavender
Alameda County, CA
Cindy Kirk
City of Bryan, TX
SALGBA
2012
ANNUAL
Jill Nohai
Extend Health
Denise Chapel
MCHCP
Gwen Feit
Ft. Collins, CO
Tina Bowling
SALGBA
Certified Government Benefits
Administrator Program
Admission Application
Name: ____________________________________________
Entity: ____________________________________________
Address: __________________________________________
__________________________________________
City, State, and Zip: ________________________________
Phone: ( ) _______________
Fax: ( ) _______________
Email: _________________________________
Guidelines are available at www.salgba.com under the Professional
Development link.
The fee to join the CGBA program is $50 and is payable by check, cash or credit card.
Please send completed form and payment to:
SALGBA
Attn. Tina Bowling
PO Box 867, Berea, KY 40403
Fax: 859-623-8694
Email: [email protected]
Page 13
STATE & LOCAL GOVERNMENT BENEFITS ASSOCIATION
2012 ANNUAL CONFERENCE REGISTRATION
San Francisco, CA—-April 15-18, 2012
CONFERENCE REGISTRATION
(Includes educational sessions, Exhibit Hall, Sunday Networking Reception, two continental breakfasts, two luncheons and Tuesday Night
Event. Additional tickets for guests may be purchased for the Sunday Networking Reception and the Tuesday Night Event.)
Please print or type:
Name:_______________________________________________________________________________
Entity: _______________________________________________________________________________
Business Address: _____________________________________________________________________
City: _________________ State: ___Zip: _____ Email: ________________________________________
Daytime Phone: (___)_____________ Fax: (___)___________
Special Accommodations Required: ______________________________________________________
ARE YOU A SALGBA MEMBER? Yes__ No__
My membership application is enclosed___
Prior to January 15, 2012 early registration fee is $25 less!
SALGBA Member
Non-Member
Student
One Day Pass
Monday
Tuesday
On or before March 21, 2012
Jurisdictional
Associate
$300____
$500 ____
$500 ____
$700 ____
$200 ____
$99 ____
$99 ____
n/a
n/a
After March 21, 2012
Jurisdictional
$400 ____
$600 ____
$199 ____
$199 ____
EVENT PLANS:
(Please help us arrange a successful event by indicating which events you plan to attend)
Sunday Networking Reception (April 15, 2012) Yes __ No __
Tuesday Night Event (April 17, 2012) Yes __ No __
GUEST REGISTRATION:
Guest(s) Registration (includes Sunday Reception & Tuesday Night Gala) _____ x $100 = _____
Guest Name: __________________________
OPTIONAL EVENT REGISTRATION:
Golf Tournament
Jurisdictional Attendee $50 ___
Golf Handicap _________
Associate Attendee $75 ___
Sunday Tour
Jurisdictional Attendee $40___
Associate Attendee $50 ____ Guest $60 ___
Guest $100 ___
PAYMENT:
Total Fee(s) Due $_________________ Check Enclosed ______
Credit Card Processing Form available online.
Ways to Register:
Register on-line at www.salgba.com or complete this form and mail with fee payment to:
SALGBA, P.O. Box 867, Berea, KY 40403, or fax to 859-623-8694.
Associate
$600 ____
$800 ____
n/a
n/a