Spring 2023 fmiAgent Point Awards Registration

Congratulations on qualifying for the Spring 2023 fmiAgent Point Awards trip to the beautiful Barcelo Maya Palace Resort in the Riviera Maya of Mexico! from Saturday, April 29, 2023 through Thursday, May 4, 2023! Please complete the form below to confirm your reservation and attendance. Thank you for your business!

1099 Information

A 1099 will be issued to the Qualifying Producer for the value of the trip.

Full Legal Name(Required)

SSN or TIN for above Legal Name(Required)

1099 Mailing Address(Required)

City(Required)

State(Required)

ZIP(Required)

Guest 1 Information

(Qualifying Producer)

Full Legal Name(Required)

(Qualifying Producer)

First Middle Last

Email Address(Required)

Mobile Phone(Required)

Date of Birth(Required)

Month

Day

Year

May we text you prior to or during the trip to the above number?(Required)

Yes

Before trip only

During trip only

Please note that we will call mobile number if needed, regardless of permission to text, for important updates or emergencies.

Guest 2 Information

Leave Blank if None. Guests 2-4 are in ADDITION to the qualifying producer.

Full Legal Name

First Middle Last

Mobile Phone

Age as of 04/29/2023

May we text you prior to or during the trip to the above number?

Yes

Before trip only

During trip only

Please note that we will call mobile number if needed, regardless of permission to text, for important updates or emergencies.

Will you have any children/additional guests in attendance in your qualified room?

Yes

*all costs associated with additional persons beyond the qualifying producer and one (1) guest are the sole responsibility of the qualifying producer

Cost for guests beyond the Producer and 1 guest staying in one room are as follows per person:

Over age 12: $777.65
Ages 2-12: $489.25

Most rooms allow up to 5 persons, with a maximum of 4 adults. Please be advised that if your qualified room category does not allow for the number of people you'd like in your room, we will reach out to you with other accomodation options.

Payment must be remitted to Financial Markets Inc for additional persons. Payment is due 02/20/2023 and is non-refundable after that date.

Please remit payments to:

Financial Markets Inc
Attn: fmiAgent trip
PO Box 3980
Rapid City, SD 57709

Child 1 Information*

*all costs associated with additional persons beyond the qualifying producer and one (1) guest are the sole responsibility of the qualifying producer

Full Legal Name

First Middle Last

Mobile Phone

Age as of 04/29/2023

May we text you prior to or during the trip to the above number?

Yes

Before trip only

During trip only

Please note that we will call mobile number if needed, regardless of permission to text, for important updates or emergencies.

Child 2 Information*

*all costs associated with additional persons beyond the qualifying producer and one (1) guest are the sole responsibility of the qualifying producer

Full Legal Name

First Middle Last

Mobile Phone

Age as of 04/29/2023

May we text you prior to or during the trip to the above number?

Yes

Before trip only

During trip only

Please note that we will call mobile number if needed, regardless of permission to text, for important updates or emergencies.

Child 3 Information*

*all costs associated with additional persons beyond the qualifying producer and one (1) guest are the sole responsibility of the qualifying producer

Full Legal Name

First Middle Last

Mobile Phone

Age as of 04/29/2023

May we text you prior to or during the trip to the above number?

Yes

Before trip only

During trip only

Please note that we will call mobile number if needed, regardless of permission to text, for important updates or emergencies.

Trip Details

Do you require an ADA accessible room?(Required)

Yes

Please describe ADA accessibility accommodations needed:

Would you like to book an additional room?(Required)

Additional rooms and associated costs are the sole responsibility of the qualifying producer. Financial Markets Inc will assist in the booking of additional rooms for qualifying producers.

Yes

Your Internal Wholesaler will reach out to you further details.

Please list any specific requests for this additional room here:

Any additional special requests or comments:

Qualifying Producer Agreement

Attendance is by invitation or recommendation of Financial Markets Inc. only. Trip qualification is not redeemable for cash or other remuneration. Qualifying Producer and one (1) guest may attend compliments of Financial Markets Inc. Any additional guests and/or expenses incurred are the sole responsibility of the Qualifying Producer; complimentary guest may not be another licensed insurance producer unless they are the spouse of the Qualifying Producer. If more than two persons will be sharing a resort room, all additional/associated costs are the sole responsibility of the Qualifying Producer. Additional incidental costs will also be the sole responsibility of the Qualifying Producer. No refunds will be provided for missed flights or cancelled vacations. No refunds will be provided for any reason. Financial Markets Inc assumes no liability for weather conditions, loss or injury directly or indirectly due to any accommodation or arrangement of the venue. Travel arrangements to and from the trip location are the sole responsibility of the attendees. Qualifying Producer is responsible to make every reasonable effort to assist in making travel arrangements in a timely manner to ensure availability of flights and accommodations. All guests are encouraged to consult a physician prior to the trip to be sure they are sufficiently healthy to travel. Financial Markets Inc does not require or ask any participant to adhere to any vaccine, social distancing, or masking procedures, but as this is a voluntary event, travel restrictions may apply. Financial Markets Inc assumes no responsibility for COVID-19 guidelines, mandates or regulations in place for travel. By checking the consent below, you voluntarily agree to assume all risks and accept sole responsibility for any expense, liability, illness, injury, disability or death related to contracting the virus while in travel to/from or in attendance of this trip.(Required)

Attendance is by invitation or recommendation of Financial Markets Inc. only. Trip qualification is not redeemable for cash or other remuneration.

Qualifying Producer and one (1) guest may attend compliments of Financial Markets Inc. Any additional guests and/or expenses incurred are the sole responsibility of the Qualifying Producer; complimentary guest may not be another licensed insurance producer unless they are the spouse of the Qualifying Producer.

If more than two persons will be sharing a resort room, all additional/associated costs are the sole responsibility of the Qualifying Producer. Additional incidental costs will also be the sole responsibility of the Qualifying Producer.

No refunds will be provided for missed flights or cancelled vacations. No refunds will be provided for any reason. Financial Markets Inc assumes no liability for weather conditions, loss or injury directly or indirectly due to any accommodation or arrangement of the venue.

Travel arrangements to and from the trip location are the sole responsibility of the attendees. Qualifying Producer is responsible to make every reasonable effort to assist in making travel arrangements in a timely manner to ensure availability of flights and accommodations.

All guests are encouraged to consult a physician prior to the trip to be sure they are sufficiently healthy to travel.
Financial Markets Inc does not require or ask any participant to adhere to any vaccine, social distancing, or masking procedures, but as this is a voluntary event, travel restrictions may apply.

Financial Markets Inc assumes no responsibility for COVID-19 guidelines, mandates or regulations in place for travel. By checking the consent below, you voluntarily agree to assume all risks and accept sole responsibility for any expense, liability, illness, injury, disability or death related to contracting the virus while in travel to/from or in attendance of this trip.

I certify that the information provided in this registration is true and correct to the best of my knowledge. I fully understand and agree to the terms and conditions expressed in this document.