2014 Florida Council Meeting Registration - IAIP A Class Act

September 11 - 13, Sarasota, FL

1.  Registration Info: (Separate form for each registrant)

Last Name: ______

First Name: ______

Designations: ______

Name to appear on badge: ______

Mailing Address: ______

City/State/Zip: ______

Daytime Phone: ______ext._____

Email:______

Employer: ______

Local Association: ______

2. Registration Fee

Full Registration by 8/15/14 (No FAIA Class) $125

Full Registration by 8/15/14 (With FAIA Class) $165

Non Member (No FAIA Class) due by 8/15/14 $155

Non Member (With FAIA Class) due by 8/15/14 $225

3. Extra meal tickets may be purchased for

Act 1 (Welcome Party) _____@ $40 each $ _____

Act 2 (Breakfast ) _____@ $30 each $ _____

Act 3 (Luncheon) _____@ $45 each $ _____

Note: All Guests MUST have a ticket for admission

4. Special Dietary Needs

Allergy (please list) ______Vegetarian

*** NOTE: Deduct $10.00 if paying by Check ***

5. Total Registration Amount______

(Payable by Check or Credit Card)

Check payable to: SW Florida Council Meeting

Credit Card Payment:

Name on Credit Card: ______

Type of Card: ______

Credit Card Number: ______

Expiration Date: ______3 Digit Security Code ______

Mail to: SW Florida Council Meeting

c/o Nancy Morris

3929 Breezemont Dr, Sarasota, FL 34232

If paying by credit card, you may wish to email your completed registration prior to 8/15/14 to:

6. Please indicate if you are one of the following:

First Timer Required to receive privileges

Gold Timer - 10+ FL Council Meetings

Young Professional (< age 40)

Member at Large CWC Speaker

Delegate Local President

Alternate Exhibitor

CPIW CPIM CIIP DAE

Will you receive your CPIW, CPIM, CIIP, or designation at this meeting?

Yes CPIW CPIM CIIP DAE

7. Continuing Education:

Thursday 9/11

FAIA 5 Hour CE - P&C Update 9:30 AM-3:30 PM

Mandatory P&C #89367 (new required course)

Produced by: Florida Association of Insurance Agents

Directed by: Jeff Odom

How to Assist Hackers & Identity Thieves

2 Hr CE #88315 Gen’l Lines & Health 9:30 AM-11:30 AM

Produced by: Harold MacFarland, Private Investigator

Automotive Glass Replacement & Repair for Insurers

3 Hr CE #89620 Gen’l Lines 12:30 PM-3:30 PM

Produced by: Glass America

Directed by: Joy Houston

IAIP Module 2 Leadership through Practical Mgmt

Accounting Skills for Supervisors

2 hrs CLP (See Note for Book**) 9:30 AM-11:30 AM

Directed by: Vickie Harmon

Friday 9/12

IAIP Module 2 Leadership through Practical Mgmt

Problem Solving & Decision Making

4 Hrs CLP (See Note for Book**) 8:00AM – 12:00 AM

Directed by: Betty Curry

Social Media & Insurance

2 hrs CE #84292 Gen’l Lines P&C 8:00 AM – 10:00 AM

Produced by: Insurance Education Corp

Directed by: Pamela Voigt

Biggert-Waters FRIA ’12 & Summary of 06/14 NFIP Changes

1 Hr CE Gen’l Lines P&C #87898 10:00 AM – 12:00 PM

Flood Related Errors & Omissions Claims

1 Hr CE Gen’l Lines P&C #87057

Produced by Torrent Flood

Directed by: Pete Travis

**Note: You must Purchase, Download & Print CLP class booklets in advance from the IAIP website. The course booklets will not be available in class.