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.