PIA Agency Membership
The top portion of the form (Individual Information) should include contact information for the Agency primary contact (Principal/Owner). The Business Information portion of the form should include the general contact information for the Agency (if different from the Individual Information).
*We will need email addresses for all covered members/licensees in order for those individuals to access their PIA member benefits.
*Any Business Categories you select will be included as search options in the "Find An Agent" directory on our website.
Please select "Invoice Me" at the bottom of the form if you wish to pay by check (please include invoice with your check payment, if possible).
Please confirm that your contact information is accurate (with correct spelling and punctuation) prior to submitting your application.
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.