2005 AIIA Calendar
About Us
AIMS
Alabama Dept. of Ins.
Contact Us
Education
Endorsed Programs
Job Postings 
Meetings/Conventions
Members' Benefits
Members' Support
Members' Web sites
Membership App.
News
News Archive
Request A Speaker
Search
Sponsors Page
StatePulse
Young Agents Page
Home
Select From Above List..
141 London Parkway
Birmingham, AL 35211
Phone (205) 326-4129
Fax     (205) 326-3086
Copyright 2005
www.aiia.org
APPLICATION FOR MEMBERSHIP
ALABAMA INDEPENDENT INSURANCE AGENTS, INC.
 
Thank you for your interest in the Alabama Independent Insurance Agents, Inc. Membership will entitle your organization to all member benefits as provided by the Association. Applicants must agree to abide by the Association Code of Ethics and By-laws, as well as Insurance statutes and regulations of the state of Alabama. This application for Membership in the Alabama Independent Insurance Agents, Inc. is not binding until notification. All members must be approved by the Executive Committee.

APPLICATION FORM
AGENCY NAME:

NAME AND CONTACT:

PERSON:

CORPORATE OFFICER OR PRINCIPAL:

MAILING ADDRESS:

CITY:

STATE:

ZIP:

PHONE NUMBER:

FAX NUMBER:

EMAIL ADDRESS:

WEB DOMAIN NAME OR URL

FEDERAL TAX ID NUMBER

LIST THE PROPERTY & CASUALTY COMPANIES WITH WHICH YOU HOLD AGENCY CONTACTS.
(You must have at least two.)

CARRIER:

EXP DATE:

NUMBER OF EMPLOYEES (For dues, please refer to the below table)
I would like information on the following AIIA member Only Programs:
Continuing Education 
Premium Financing 
Rating Systems 
Errors & Omissions Coverage 
EPL Products 
Umbrella Products 
Upcoming Meetings 
Work Comp Products 
Long Distance Carriers
Calculating Semi-Annual Dues


Number of  Employees

100 & over
50  - 99
30 - 49
23 - 29
17 - 22
14 - 16
13
12
11
10
9
8
7
6
5
4
1 - 3 employees
 
Semi-Annual Dues

 $1,313.00 
 $1,082.00 
 $1,029.00 
 $   977.00 
 $   924.00 
 $   872.00 
 $   819.00 
 $   767.00 
 $   714.00 
 $   662.00 
 $   609.00 
 $   557.00 
 $   504.00 
 $   452.00 
 $   400.00 
 $   347.00 
 $   263.00
 
This is an application ONLY. Pay your dues after acceptance
from the Members Support Page


Thank You For Filling out this form!
 2005 AIIA Calendar, About Us, AIMS, Alabama Dept. of Ins, Contact Us, Education, Endorsed Programs, Job Postings Meetings/Conventions, Members' Benefits, Members' Support, Members' Web sites, Membership App., News
News Archive, Request A Speaker, Search, Sponsors Page, StatePulse Young Agents Page, Home