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 ASSOCIATE 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. COMPANY 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: TYPE OF COMPANY: 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