Full Registration

You can mail in your registration by printing the form below.

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*

Conference Information
Will you attend the annual conference?*
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 · January 28‐29, 2021 · To Be Determined, USA
- No, I am unable to attend the conference

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 7, 2020.
Name
First Last
Email
Years at bank
Position/title
Guide Address
- Address is same as above
Guide Address
Street Address City State ZIP Code

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

Pricing Information
Three annual payments of $3,600 due by August 15, 2020, 2021, and 2022. ($3,850 if registering after August 15)
Payment Information*
- Check
- Invoice me
- Credit card
Please make check payable to Cain Ellsworth & Company, LLP, 1008 3rd Avenue, Sheldon, IA 51201 or 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 x 550px).
Cancellation Process: Participants will be refunded their registration fee in full if we are notified of their withdrawal in writing by September 1, 2020. After this date, participants will be eligible for a prorated refund of their registration fee.

Bio Information