Affiliate Membership Application (New Members Only

Instructions

Thank your for your interest in becoming an affiliate member of PIIAC. Please fill out the form below to apply for your membership and one of our team members will be in touch with you to complete the application process. Your membership is not effective until confirmed with a PIIAC team member and payment has been received.

Affiliate membership is available to auto body, auto rental, glass, restoration, and technology companies.

• Aﬃliate members of PIIAC may participate in association activities and receive member pricing.

• Affiliate members are listed on the PIIAC website with their logo and link to their website.

• Affiliate members have access to the list of current agency members upon request. Email Addresses excluded.

• Affiliate members are listed in quarterly magazine as Affiliate Member.

• Membership does not carry voting privileges nor include membership with Independent Insurance Agents and Brokers of America (IIABA).

Dues to PIIAC are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense. A portion of the dues, however, is not deductible as an ordinary and necessary business expense to the extent the association engages in lobbying. The non-deductible portion of the dues will be available after February 15.

All memberships renew November 1st of each year, regardless of join date.

Select An Option

Affiliate $775 Annually

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