LOMA Event Registration - Cincinnati

First Name:
Last Name:
Email Address: Email Address Verify:
Company:    If other:
Phone (ex: xxx-xxx-xxxx) :    Extension:

LOMA/LIMRA Designations (put recently earned in [brackets]):

For lunch I would like to order:

I will pay my $40.00 (Regular Member) or $50 Guest Registration to LOMA Society of Ohio: By Mail At the Door All In Member (no charge)

By Mail to:
Attention: Renee Prevatte - LSO
400 Broadway MS 82
Cincinnati, OH 45202