2026 Midwest Legislative Conference Registration Form

Name

First NameLast Name

State Farm Bureau

Title

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Will you attend the tours on Tuesday, July 21?

YesNo

Will your spouse and/or children be attending? If so, please add their name below.

Please let us know how many will be attending each meal function.

Sunday Welcome Dinner

Monday Breakfast Buffet

Monday Boxed Lunch

Monday Dinner at Wilderness Ridge

Tuesday Breakfast Buffet

Tuesday Boxed Lunch

Tuesday Dinner at Round the Bend Steakhouse in Ashland, NE

Wednesday Breakfast Buffet

Conference Registration Fee

Registration Fee

$150.00 Quantity

Bob Bash Golf Tournament

Golf tournament at Wilderness Ridge Golf Club on Monday, July 20

$140.00 Quantity

Total

$0.00

Card Information

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Zip Code

Country