PIA Agency Membership

Instructions

The top portion of the form (Personal Information) should include contact information for the Agency Principal/Owner. The Business Information portion of the form should include the general contact information for the Agency (if different from the Personal Information).

Please select "Invoice Me" at the bottom of the form if you wish to pay by check (please include invoice with your check payment).

NOTE: PIA dues are not deductible as charitable contributions for income tax purposes. However, 82.5% of your dues may be deductible as a business expense.

Select An Option

Agency Membership

$370 - Base Agency Membership Dues (includes up to two licensed principals/licensed employees from the same primary agency location).

If you wish to pay by check please select the Invoice Me option.

***Additional Charges to Base Membership Dues***

$25.00 - Per additional licensed agency employee at primary location (beyond the two included in base Membership dues).

$50.00 - Per additional agency location (includes one licensee at that location).

$25.00 - Per additional licensee at each additional location (beyond the one included in the Additional Location fee).

$25.00 - Per Retired Agent. Retired Member (RM) = former member that is no longer actively engaged as a principal/licensee in the independent insurance agency or brokerage business but would still like to receive any applicable member benefits.

Membership Classifications: Active Agency Members are persons actively engaged as a licensee in the independent insurance agency or brokerage business. All active members have full voting rights.

PIA dues are not deductible as charitable contributions for income tax purposes. However, 82.5% of your dues may be deductible as a business expense. FEIN#: 03-0477063

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameBusiness Name

Please select a valid membership option and fee item if exist