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Registration Form The New Jersey Council of Insurance Professionals invites you to come grow with us in NJ at the IAIP Region I Conference/annual meeting. Join us March 30th to April 2nd, 2017 in Princeton, NJ. We have planned a fun welcome event on Thursday night. On Friday, we have three branches of learning for all – CE classes, CLP classes, and FIT classes. Our first meeting will be on Friday night with dinner and a speaker. Saturday’s agenda includes the CWC Competition, Business Meeting, Awards Luncheon, and Banquet. We are also offering an excursion to the Grounds for Sculpture in the afternoon. We will end with a final breakfast meeting on Sunday Morning. The hotel is about 15 minutes from downtown Princeton and the University. There is also shopping at several malls within 30 minutes (and several wineries). We are doing a fundraiser to benefit Ronald McDonald House of New Brunswick/Long Branch and hope to see many sets of red-striped legs on Thursday night! We are also collecting pop tabs from cans, so please start collecting now and bring them with you. We have been working very hard to make this a successful event for all who attend. So please come join us for Networking, Education, and Region 1 business meeting – Growth is a Choice! Yours in Fellowship, Rose M. Romaine, AAI, ACSR, CIIP, CLCS & Patricia Ulrich, RN, AIC, AIM, AIT, CPIW 2017 Region 1 Conference Co-Chairs Last Name: _______________ “Growth is a Choice with IAIP in Princeton New Jersey!” 2017 Region I Annual Meeting March 30th – April 2nd, 2017 Marriott at Forrestal, Princeton 100 College Road E, Princeton, NJ 08540 (609) 452-7800 Registration Form 1. Registration Information – Please Print Clearly Name as it should appear on badge: IAIP Member Since: 2. Name: ________________________________________________ ______________________________ __________________ Designations: Mailing address: _______________________________________________ _______________________________________________________ City/State/Zip: ________________________________________________ Employer: Is this your ☐ office or ☐ home mailing address? _______________________________________________________ Local Association: Daytime Phone: _____________________________________ Ext: ______ _______________________________________________________ E-mail: ______________________________________________________ I AM A: ☐ First Timer ☐ PRO ☐ YNP E-mail will be used for confirmation and updates. ☐ ☐ GIS 25 Year Member All information listed above will be printed on the Conference Roster. ☐ Legacy Foundation Donor (Have Donated $25 or more as a ☐ Please check if you do not want your e-mail listed on the roster. Pacesetter or Trendsetter) 2. Full registration includes: Admission to all meetings, non-CE classes, meals from Thursday Night through Sunday Breakfast and close of meeting, EXCEPT for FRIDAY LUNCH. For full registration, please check the events you are attending and your meal choice(s) where applicable. Full Registration Fee (Members): Full Registration Fee (Non-Members & Guests): ☐ Early Bird Registration prior to 2/15 $ 285 ☐ Early Bird Registration prior to 2/15 $ 300 ☐Registration prior to 3/5 $ 300 ☐ Registration prior to 3/5 $ 325 ☐ Registration after 3/5 $ 325 ☐ Registration after 3/5 $ 350 ☐ CE Classes(es) on Friday (total cost for 1 or more) $ 10 ☐ CE Class(es) Friday $ 25 ☐ Friday Grab and Go Lunch $ 15 ☐ Friday Grab & Go Lunch $ 15 ☐ Show Us Your Stripes Socks $ 10 ☐ Show Us Your Stripes $ 10 A la Carte Registration Fees (Please check which you will be attending, if not a full registration). ☐ Thursday Welcome Party w/Sponsors 6:30-11 $70 ☐ Saturday Breakfast 7-9 $25 ☐ Friday Education - $25 per class $ ___ ☐ Saturday Awards Luncheon 12-2:30 $60 ☐ Friday Breakfast 7-9 $25 ☐ Saturday Banquet 6:30-11 $75 ☐ Friday Grab & Go Lunch 12-1:30 $30 ☐ Sunday Breakfast & Closing Session 8-11 $35 ☐ Friday Dinner & Keynote Speaker 6:00-9:00 $60 For “Full Registration” attendees – please check all items you plan to attend. ☐ Friday – First Timers Breakfast 7:30-8:30 ☐ Saturday – Awards Luncheon 12-2:30 ☐ Friday – Breakfast 7-8:30 ☐ Saturday – Banquet & Keynote Speaker 6:30-11:30 ☐ Friday – Grab & GO Lunch 12-1:30 ☐ Beef ☐ Fish ☐ Vegetarian ☐ Turkey ☐ Roast Beef ☐ Vegetarian ☐ Friday – PRO’s Luncheon 12-1:30 ☐ Sunday – Breakfast and Closing Session 8:30-10:30 ☐ Saturday Breakfast 7-8:30 Special/Dietary Needs In accordance with Title II of the Americans with Disabilities Act, we invite all registrants to advise us of any disability and any request for accommodation for that disability. Your request should be submitted in writing as far as possible in advance of the conference. ☐ Nut Allergy ☐ Diabetic ☐ Vegetarian ☐ Shellfish Allergy ☐ Gluten Allergy ☐ Other Request: __________________________ 3. Member Ribbons: Received your CIIP/CPIW/CPIM, CLP or DAE since the last Annual Meeting? ☐ Yes – CIIP/CPIW/CPIM ☐ Yes – CLP ☐ Yes –DAE ☐ Alternate ☐ CPIM ☐ Delegate ☐ Past Council Director ☐ Assistant (to RVP) ☐ CPIW ☐ Exhibitor ☐ Past Regional Officer ☐ CIIP ☐ Current Local President ☐ First Timer** ☐ Young and New Professionals* ☐ CLP ☐ Current RVP ☐Legacy (Pacesetter or Trendsetter) ☐ 25+ Year Member ☐ Council Director ☐ CWC Contestant ☐ Member-at-Large *Young & New Prof are members Age 40 and under and ☐ Council Director Elect ☐ DAE ☐ National Officer in industry <5 years. **1st Timers those attending their 1st Annual Meeting 4. Seminars/Workshops: CE’s filed for CT, MA, ME, NH, NJ, NY, PA, RI & VT Please see attached description of all classes. ☐ E&O – 3 CE ☐ FIT – Health & Your Spine (no CEU’s) ☐ Fire Cause & Origin – 3 CE ☐ FIT – Nutrition and Movement (no CEU’s) ☐ Ethics – 3 CE ☐ FIT – Mind, Stress, and Meditation (no CEU’s) ☐ Flood (different from last year) – 3 CE ☐ CLP – Why We Struggle With Tough Decisions - 4 Hours (no CEU’s)* ☐ CLP – Financial Intelligence – 2 Hours (no CEU’s)* *FOR ALL TAKING CLP CLASSES, PLEASE PURCHASE ONLINE FROM NATIONAL THE ☐ CLP – How to Make Yourself Indispensable - 2 Hours (no CEU’s DOWNLADABLE STUDENT GUIDE, PRINT IT, AND BRING IT WITH YOU! 5. Excursions: ☐ Grounds for Sculpture (Space limited to 50 per bus) – Cost $17 (includes ticket and transportation) – Saturday Leave 2:30 PM and return at 6 PM 6. Payment Information: By submitting the registration form, I agree that I have read the information below regarding payment information, and to abide by the terms therein. 1. Full Registration $ __________ 2. Friday Grab & Go $ __________ 3. Education Fees $ __________ 4. A La Carte $ __________ 5. Excursion $ __________ TOTAL COST: $ __________ My check is enclosed in the amount of $ __________ Please make check payable to: NJ Council IAIP Mail Registration to: c/o Mary Corvaia 21 Westwood Avenue Bridgeton, NJ 08302 Questions on Registration? – Contact Mary Corvaia at 609-319-7175 or email: [email protected] All Cancellations Received by March 16, 2017 will incur a $50 processing fee. No Refunds after March 16, 2017 Return Check/NFS Fee is $15 By offering both a full registration as well as a la carte, we can provide cost effective options. In doing so, we still need to know what you plan on attending for planning purposes and to give accurate counts to the Hotel. Please be sure to check off all that you will be attending. Reminder: Hotel Reservations must be made separately directly with the Marriott at Forrestal Princeton 609-452-7800 Be sure to mention that you are attending the “IAIP Region I Conference” for the special conference rate of $159 per night plus applicable taxes. Friday Education Day CE Classes: 8:30 a.m. to 11:30 a.m. Errors & Omissions 3 Hour CE Course - Presenters Marie Reilly, Esq., Roy Brandow and Yvonne A. Butta This course focuses on the circumstances that trigger Error & Omissions claims; the potential exposures found in Customer Service, Claims, Underwriting, Finance and Agency; how to prevent an Errors & Omissions situation; the steps involved in investigating an Error & Omissions claims; and what is covered as well as who is covered under the Errors & Omissions policy coverage. A real life sample case will be acted out and resolved in the class. This is a 3 CE Credit Course for agents, brokers, underwriters and adjusters; as well as 3 CLE CE Credits for attorneys in Pennsylvania and New Jersey since this class had been previously approved for CLE credits in these two states. 8:30 p.m. to 11:30 a.m. Flood Insurance 3 Hour CE Course Presenter Livia Hillmyer This course will provide attendees the opportunity to refresh their knowledge about the National Flood Insurance Program, expand their understanding about the rating of the policy, learn that a building built in compliance does not always mean that it will be an inexpensive flood premium and review the recent law changes and how it affects the rating of the policy. 1:00 p.m. to 4:00 p.m. Fire Cause & Origin 3 Hour CE Course - Presenter Nicholas Palumbo This course will provide the student with a better understanding of the working of a fire loss investigation from the insurance carrier's point of view. The students will get a good understanding of how a Private Investigator supplies the needed expertise to the claim. 1:00 p.m. to 4:00 p.m. Insurance Ethics 3 Hour CE Course Presenters Marie Reilly, Esq. and Yvonne Butta This class will go over the basics of Ethics conduct for client, carrier, underwriter as well as society; the definition of proper conduct; the legislation as well as the legal Ethics concepts; the Criminal as well as Civil Actions arising from improper conduct; the various violations of Ethical Codes; and the reasons why all insurance professionals, today, need to exercise Ethical conduct during the soliciting, sale, negotiations as well as transactions of insurance related business. We will discuss everyday sample situations to illustrate the practical application of Ethics codes and the concepts discussed during the class. This is a 3 CE Credit Course for agents, brokers, underwriters and adjusters; as well as 3 CLE CE Credits for attorneys in Pennsylvania and New Jersey since this class had been previously approved for CLE credits in these two states.
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