Full Registration

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Bio Information
Brief Bio*
Brief bio (under 100 words) OR fill in the fields below and we will create a bio based on your information. This bio will be used in the participant directory available to all Academy participants.
Professional Designations*
Education*
Background in banking*
Hobbies/Interests/Family*

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Conference Information
Conference Information:*
This will serve as your registration for the annual conference. You are responsible for hotel and travel arrangements. We strongly recommend that all participants attend the annual conference. Registration is limited.
- Yes, register me for the annual conference • February 1-2, 2024 • Tempe Mission Palms Hotel, Tempe AZ
- No, I am unable to attend the conference

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Guide Information
If you do not yet have a guide, please leave these areas blank and inform us when you have identified the individual. The first guide webinar is scheduled for Wednesday, October 4, 2023.
Name
First Last
Email
Years at bank
Position/title
Guide Address
- Address is same as above
Guide Address
Street Address City State ZIP Code

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Administrative contact
This is the primary contact at the bank for billing or other administrative purposes (optional).
Name
First Last
Email
Position/title
Admin Address
- Address is same as above
Guide Address
Street Address City State ZIP Code

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Pricing Information
Three annual payments of $3,295 due by October 1, 2023, 2024, and 2025. ($3,595 if registering after October 1)
Payment Information*
- Check- Please make check payable to Cain Ellsworth & Company, LLP, 1008 3rd Avenue, Sheldon, IA 51201
- Invoice me
- Credit card (There will be an additional 3% processing fee) To pay by credit card, contact our office at (712) 324-4614 or [email protected]
Application Process: Please email this form along with a photo (head and shoulders only) to [email protected]. The photo will be used in the participant bio and should be printable at a minimum of 2 x 2.75 inches (or 400 × 550px).
Cancellation Process: Participants will be refunded their registration fee in full if we are notified of their withdrawal in writing by October 15, 2023.

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Bio Information