Please fill out the information below and click on Submit. You will then be transferred to a secure server to process your billing information.  For your address please enter your business address.

Please note that there has been a change to the dues structure. Starting in 2009 members that are currently employed by an insurance company are exempt from dues. Company members MUST still fill out the below form.

If you would like to pay by check please click HERE.

Membership Dues: $75.00

Credit Card Processing Fee: (2.5%) $1.88

Are you a company member (currently employed by an insurance company)? Yes No

Are you planning to attend the annual conference?  _ Yes No

Would you like your name removed from the membership list? Yes No