Event Registration _Columbia

Thank you for supporting SCHB Self Insurers Fund!

You and your family are invited to our Agency Appreciation Night on Tuesday, July 20, 2021. Watch the Columbia Fireflies take on the Augusta Greenjackets. The gates will open at 6:00 PM, and dinner will begin at 6:00 PM.

Parking is available on-site at Segra Park. The event will be held rain or shine.

Please RSVP by Tuesday, July 6, 2021, and complete this form to register for the event. Include your name, email address, phone number, and the name of your agency, plus additional individuals from your agency that will be attending (up to five individuals including yourself). We look forward to seeing you!

Name*
First Last
Email*
Phone*
Company Name*
How many people are you registering (including yourself)*
Participant #2
First Last
Participant #3
First Last
Participant #4
First Last
Participant #5
First Last
Photography will be taken during the event. Do we have everyone's permission to use their images in promotion materials?*
- Yes
- No
Phone
This field is for validation purposes and should be left unchanged.