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REGISTRATION FORM

OCTOBER 5-7, 2022

RADISSON HOTEL & CONFERENCE CENTER

GREEN BAY, WI

Please fill out the form below to register you (and your guests) for the ASCEND Conference. You do not need to submit the form if you are not attending the ASCEND Conference. Once you submit the form, you will be directed to a page with online payment options. The conference fee is $100 per Representative registration, $25 per additional guest, per day, and an additional $25 per guest for the dinner and awards ceremony. Registration closes September 22nd.

If paying by check, please send to:


Packerland Brokerage Services

ATTN: Mara Maidi

432 Security Blvd.

Green Bay, WI 54313

PLEASE FILL OUT THE FORM BELOW. THE FORM MAY TAKE A SECOND TO LOAD.

PLEASE ONLY FILL OUT THIS FORM IF YOU ARE ATTENDING THE ASCEND CONFERENCE IN GREEN BAY, WI.

REPRESENTATIVE REGISTRATION

REPRESENTATIVE INFORMATION

Representative Name*

This is how it will appear on your nametag.

City & State*

Note your city and state for nametags.

ANNUAL REQUIREMENTS FOR ALL REGISTERED REPRESENTATIVES

Compliance & Firm Element / Anti-Money Laundering (AML) Required Courses

Representatives may complete a portion of their annual requirements at the ASCEND Conference or take all of the courses online through our vendor, Quest CE. The requirements and options are outlined below. Please select the best option for you. The deadline to complete all requirements is 12/31/2022. Please do not need to fill out this form if you are not physically attending the conference. You can fulfil your requirements online through Quest CE without submitting this form.

Annual Requirements Available at Conference or Online:

The Annual Compliance Meeting and Firm Element Part 1/Anti-Money Laundering courses must be completed at conference or online (online opens 10/10). The conference materials will become available online the week following this annual conference.

Annual Requirements Available Online Only:

Firm Element Part II and the Compliance Questionnaire must be completed online by all Representatives. These requirements are available online only (online opens 10/10).

Annual Requirements (Select One Requirement Option)

If you selected an "ONLY" option, please note that you must take the remaining course (Firm Element Part I/AML or Compliance) online in addition to the required online courses (Firm Element Part II and Compliance Questionnaire).

Fees:

  • $125 is the discounted fee for the required online courses if you attend the ASCEND Conference, even if you choose to take all of the courses online after conference. The $125 is in addition to the conference fee of $100 (additional $25 per guest). You will be invoiced $125 for the courses after conference.

  • $250 is the fee to complete courses online if you don't attend the ASCEND Conference.

  • Since Packerland has prepaid all fees to Quest CE (online course vendor), you do not need to pay prior to taking the courses online. Just sign-in and complete. You will receive an invoice for your courses after conference.

Deadline:

The deadline to complete all of your requirements is 12/31/2022.

Vendor:

We are using Quest CE as the vendor again in 2022 - this has made the annual requirements process and online interface more user friendly for everyone.

Questions? Contact:

Chad Rohm, Compliance Officer, at chadr@pbshq.com (920-662-9500) or Victor Kuehl, Compliance Specialist, at victork@pbshq.com (920-662-9500).

GUEST OR ASSISTANT INFORMATION

Do you have guests or assistants joining you? Please fill out the information below for them ($25 fee per person / per day).

Is this person a guest or an assistant?
Guest/Assistant #1 Day(s) Attending
If Guest/Assistant #1 is attending the Awards Dinner on Thursday evening (which would cost an additional $25 even if they're already attending during the day on Thursday), what is their meal choice?
Is this person a guest or an assistant?
Guest/Assistant #2 Day(s) Attending
If Guest/Assistant #2 is attending the Awards Dinner on Thursday evening (which would cost an additional $25 even if they're already attending during the day on Thursday), what is their meal choice?

ADDITIONAL ACTIVITY INFORMATION

Please select the number of attendees for each additional activity you and/or your guests/assistants are planning to attend. Reminder that the Dinner and Awards Ceremony will be an additional $25 for guests and assistants.

If you are attending the Awards Dinner on Thursday evening, what is your meal choice?

SUPER CE SESSION

Friday, October 7, 8:00 - 12:00 PM

Friday Session

EMERGENCY CONTACT INFORMATION

CONFERENCE IMAGE RELEASE

Your registration and attendance at this event indicates your consent to be photographed and to the use of your image in marketing collateral and for other promotional/editorial activities of Packerland Brokerage Services - for future use in any and all media, now known or hereafter created. From time to time, Packerland Brokerage Services uses photographs of conference events in our marketing materials; by virtue of their attendance, all conference visitors agree to the use of their likeness in such materials. Packerland Brokerage Services also reserves the right to use such images taken at the conference with your photograph and/or likeness on our website, social media, and/or in future new media channels to promote the organization. If you do not agree to this, please note in the comments below.

QUESTIONS/COMMENTS

Please note any questions or comments and someone from Packerland's Home Office will contact you shortly, or you can contact Mara Maidi at maram@pbshq.com (920-662-9500) or Danielle DeJardin at danielled@pbshq.com (920-662-9500). 

PAYMENT OPTIONS

There are two convenient ways to pay for the 2022 ASCEND Conference: online via credit card (you will select your registration cost below), or by check (we will send you an invoice). 

Please select one option below.

Payment Choice

If you chose "CREDIT CARD", please indicate your conference registration cost below, including guest(s) registration. Once you do this, submit the registration form. It will ask for your payment information afterwards. 

If you chose "CHECK", please skip the payment section below and click the orange "SUBMIT REGISTRATION FORM" button.

 

Paying Via Credit Card:

For calculating your cost below, the conference fee is $100 and the guest fee is $25 per guest / per day, plus an additional $25 per guest if they are attending Thursday's Awards Dinner. Please indicate the correct price below according to the guests you listed.

For example, one guest attending Thursday's sessions and Thursday's Awards Dinner will be an additional $50 added to your $100 conference registration fee. Two guests attending all sessions and the Awards Dinner, would be an additional $150, making your total $250. 

CREDIT CARD: Select Your Conference Registration Total Cost

Thank you for registering!

CONTACT US

If you have any questions or comments, please contact Danielle DeJardin

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