National Association of Public Insurance Adjusters National Association of Public Insurance Adjusters

Learn About NAPIA > Affiliate Membership Application

Instructions:
  1. Fill out this form
  2. Contact NAPIA at the phone number below for payment.

Application For Affiliate Membership
National Association of Public Insurance Adjusters

21165 Whitfield Place, #105
Potomac Falls, VA 20165
(703) 433-9217
FAX: (703) 433-0369

Affiliate Member: Individuals, partnerships, and corporations not engaged to any extent in the profession of Public Insurance, shall be eligible for Affiliate Membership.

AFFILIATE MEMBERSHIP CATEGORIES AND DUES:

1) Vendor/Supplier.....................$1,440

This category of membership shall include vendors or suppliers of goods and services to Public Insurance Adjusters. A "Vendor/Supplier" Member shall not participate in the business meetings of the Association or vote on Association matters. Vendor/Supplier Members will be provided with a complete mailing list of NAPIA members to be used in the promotion and solicitation of their business. The list is the property of NAPIA and will not be distributed without permission of the Association. Vendor/Supplier Members may also use the slogan "Affiliate Member of NAPIA" in advertisements appearing in NAPIA publications or at membership meetings of the Association. No reference to membership may be used in any other form of written, printed, or oral material. Violation will subject the Vendor/Supplier Member to forfeiture of dues, followed by suspension of all membership privileges. Vendor/Supplier Members will be entitled to use 50% of annual dues as an advertising credit at any NAPIA sponsored function or in any publication of the Association. The use of the NAPIA logo at any time is prohibited. Vendor/Supplier Members shall also be entitled to attend all NAPIA functions at the member rate. Individual attorneys and accountants are not intended to be included in the Vendor/Supplier Member category.

2) State Association..................$720

The executive director , legal counsel or other designated representative of a state association may join NAPIA as a "State Association" Member and attend all functions at the member rate. A mailing list of NAPIA members in the state will be provided for use in contacting prospective state association members. The use of the NAPIA logo and/or designation of Affiliate Member is prohibited. Violation will be subject to forfeiture of dues, followed by suspension of all membership privileges.

3) Individual...........................$720

Any individual who services the profession of public insurance adjusting and wishes to support the efforts of the Association may join NAPIA as an "Individual" Member. Membership includes no rights or privileges other than to acknowledge the good works of the Association and a desire to support the professionalism and integrity of the industry. The use of NAPIA logo and/or designation of Affiliate Member is prohibited. Violation will subject the Individual Member to forfeiture of dues, followed by suspension of all membership privileges. Individual members may attend all NAPIA functions at the member rate. Attorneys and accountants are eligible to participate as Individual Affiliate Members.

ANSWER ALL ITEMS FULLY. * denotes a required field

The applicant understands and agrees that the submission of an application for membership in NAPIA by e-mail or facsimile shall be considered and will constitute a signed application. There shall be no requirement for a signed original if the applicant prefers to and does submit an application by e-mail or facsimile.

     Vendor / Supplier
     State Association
     Individual
	
Name of Official Representative:  *
Name of Alternate Representative: 
	 
        Firm name:  *
 Business Address: 
             City: 
            State: 
              Zip: 
            Phone: 
       Fax Number: 

           E-mail:  *
     Web Site URL: 
              
Your position & the significant specialty(ies) of your products and/or services 
   to the public adjusting profession:

    


List business or professional organizations of which you or your firm is a member:

    

Have you or your firm ever been reprimanded or disciplined by any Insurance Department 
  or other goverment agency?  If answer is yes, furnish full particulars.

     

Does your firm maintain an E & O insurance policy? 
  	 Yes  No

Recommended by: 

Proposed by: 

I authorize NAPIA to contact me by fax and e-mail until otherwise notified:  Yes  No
Today's Date: 5/22/2013
 

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