Membership Update, New Membership and Membership Renewal form
STEP 1
Fill out the membership form
Are you filing an update, new membership or renewal? Update New Member Renew Membership
Are you a : Carrier/Staff Adjuster Independent/Public Adjuster

Associate (Service) Member

line

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

NOTE: MEMBERSHIPS RUN FROM JAN-DEC EACH CALENDAR YEAR. Renewal emails will be sent out in December 2012 for the year running January - December 2013.

Please contact Robin Werth at: membership@aicaonline.org with any questions.
line
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)
line

 
Copyright © 2008-2011 Arizona Insurance Claims Association.
All rights reserved.
2303 N. 44th Street, Suite 14-1502 Phoenix, AZ 85008