AICA Membership Update Page

Membership Update and New Membership form
STEP 1	Fill out the membership form
Are you filing an update or a new menbership?	Update New Member
Are you a :	Carrier/Staff Adjuster Independent/Public Adjuster Associate (Service) Member

*This is an INDIVIDUAL membership, not a company membership. If multiple persons from your organization wish to become members, each needs to fill out this form.* Annual Membership Fees: Carrier Adjuster - FREE/Calendar year Independent Adjusters - $25.00/Calendar year Associate (Service) Member- $75.00/Calendar year Please contact Jenifer Kimbrell at: aica@pinnaclerestore.com or telephone, (480) 206-4297 with any questions.

Name:
Company:
E-mail:
Preferred Mailing Address:
City/State:
Zip Code:
Home Phone: Format (xxx) xxx-xxxx
Business Phone: Format (xxx) xxx-xxxx
Fax: Format (xxx) xxx-xxxx
Licensed? (State)