Membership Application - California

Please take a moment and fill out the application below.

Interests

As a new member, I am especially interested in:

Agency Procedure Manual
Legislative Issues
Competitive E&O Rates
Yellow Pages Advertising
Broker Bonds
Continuing Education
Regulatory Issues

Select Your Membership

FULL MEMBER
All persons duly licensed with the California Department of Insurance who are engaged in the independent insurance agency/brokerage business, and, either in their own name or name of the agency/brokerage with which they are associated, represent two or more property and casualty companies. The agency/brokerage must not be owned by any insurance company, bank, savings & loan or other financial institution.

How many staff members do you currently have?

Monthly Subscription
Yearly Subscription

Staff of 2 or less - $40.00 Monthly

Staff of 2 or less - $480.00 Annually

Staff of 3 to 5 - $48.00 Monthly

Staff of 3 to 5 - $576.00 Annually

Staff of 6 to 10 - $58.00 Monthly

Staff of 6 to 10 - $696.00 Annually

Staff of 11 to 15 - $75.00 Monthly

Staff of 11 to 15 - $900.00 Annually

Staff of 16 to 25 - $98.00 Monthly

Staff of 16 to 25 - $1,176.00 Annually

Staff of 26 or More - $120.00 Monthly

Staff of 26 or More - $1,440.00 Annually

COMPANY SUBSCRIPTION
For Companies, GAs, and others interested in receiving news e-mails, the Management Memo and supporting Alliance goals.

Company Subscription - $1,000.00

Required Information

Agency Name

Address

City

State

Zip Code

Phone Number(s)

Fax

E-mail

Website

Current E&O Carrier

Licenses

P&C L&C

License Number

License Expiration Date

Owner(s) or Manager

Owner(s) Phone Number

Residence Address

Residence City

Residence State

Residence Zip Code

Office Manager or Key Person

Number of Other Staff Members

Other Assocation Memberships

List Your Top Four (4) Companies Represented and Volume

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