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Event Registration

    Event Selection - CLICK FIELD TO SELECT YOUR EVENT (required)

    First Name (required)

    Last Name (required)

    Email (required)

    Phone (required)

    National Producer Number (NPN)

    Caller/Staff/Manager Name (if applicable)

    By checking this box, you consent to receive text messages from Empower Brokerage and/or a licensed Empower Brokerage agent. These messages may include marketing messages (e.g., promotions, reminders) and follow-up communications related to your inquiry to the number provided, which may include the use of an autodialer. Message and data rates may apply. Message frequency varies. You can unsubscribe at any time by replying STOP or clicking the unsubscribe link.

    By clicking and submitting this form with my name, phone number, and e-mail address, I agree that I am at least 18 years of age. I understand that I am enrolling in an ongoing marketing campaign about insurance services and other options from Empower Brokerage or an Empower representative, and I will receive phone calls and e-mails (even if that phone number is on any Do Not Call Registry or is a mobile number). If you want to opt out of receiving future e-mails from Empower Brokerage, you can do so at any time by clicking the “unsubscribe” button in our e-mail. For more details, see our Privacy Policy.

    *If you do not see your event listed, email lculp@empowerbrokerage.com