Florida Association of Insurance Agents

2011-2012 FAIA Council/Task Force Appointment Request Form

Note: Please be sure to fill out this form by July 1, 2011.
*Required Field

General Information
*Name:
*Agency:
Member Id:
Job Title/Position:
Mailing Address:
City:
Zip:
*Phone:
Fax:
*Email:

Areas of Interest Areas of Interest or Expertise: (Please mark preference as 1, 2, 3 with 1 being 1st choice). Please note that if you currently serve on a Task Force, you still must complete and return this form to continue serving.
Education Council
	Curriculum
	InVEST
Legislative Council
	Agent and Agency Issues
	Grassroots Coordination/PAC Fund Raising
	Market and Industry Issues Task Force
Membership and Operations Council
	Agency Automation & Technology
	Catastrophe Zone Coordinators
	Trusted Choice (must be a Trusted Choice Member)
Young Agents Council
	Events
	Membership
ATTENTION AGENCY PRINCIPALS
	Enter YES if your agency is interested in mentoring a new FAIA member

Experience
*Years of Experience in Insurance Industry:
*Describe any experience you have in reference to selected operations and councils above: