Membership Categories

• Member
  Any Fire, Casualty or Surety Agency Which has conducted business as an established agency in Central New York for at least one year is eligible, provided the agency is a member of IIABNY or PIA – NY.
  $35 per agency principal/producer; $300 maximum

• Associate Member
  Any Fire, Casualty or Surety Company that is an admitted carrier in New York State.
  $50 per named individual; $150 maximum

• Affiliate Member
  Vendors providing services to independent insurance agencies.
  $100 annual

All applications are subject to approval of the voting membership Associate and affiliate members cannot seek board positions or vote on issues.

Please print and mail to:
IIACNY c/o Linda Dardaris
Haylor, Freyer Coon, Inc.
PO Box 4743 Syracuse, NY 13221-4743

MEMBERSHIP APPLICATION

Name:_______________________________________________________

Title:________________________________________________________

Position:_____________________________________________________

Company Name:_______________________________________________

Address:_____________________________________________________

____________________________________________________________

Business Phone:_______________________________FAX____________

Email Address:________________________________________________

Membership Type
Member___________ Associate______________ Affiliate______________

Other Named Individuals_______________________________________

___________________________________________________________

Who may we thank for referring you to membership?__________________

Associate & Affiliate Agreement
I (we) acknowledge Associate and Affiliate members have the right
to attend all IIACNY events and receive its monthly publication.

I (we) agree that I (we) cannot use any trademark, servicemark or
logo of this Association in any manner whatsoever in the conduct of
my (our) business.

Name:______________________________________________________

Title:_______________________________________________________

Date:_______________________________________________________

Signature:__________________________________________________