YAC Membership Application

 

Note: Note: Only agents who work for FAIA member agencies are eligible for membership in the Young Agents Council. Learn more about agency membership and apply.

Thank you for your interest in joining the Young Agents Council! Membership is open to all FAIA members who have been in the businesses fewer than 10 years or are younger than the age of 40. Membership in the Young Agents Council will help you develop more effective relationships with carriers and underwriters, expand your professional network, and provide a forum for learning about and participating in political advocacy.

Application Information
Application Type:
*Name:  
*Agency:  
*Date of Birth:  
Member Id:  
Job Title/Position:
Insurance License No.:
Year You Received License:
Are you interested in having a mentor?:

If yes, do you prefer one in your area or outside your area?
Street Address:
City:
State:
Zip:
County:
*Phone:  
Fax:
*Email:  
Are you interested in joining a task force?:
If yes, which task force would you like to join?:
Comments:


Pricing and Rates 
YAC Membership - $50:
$25 FAIAPAC donation (non-refundable):


Credit Card Information:
* Credit Card:
* Credit Card No: ---
* V-Code:
* Expiration Date: (mm/yy)
* Credit Card Billing Address:
* City:
State:
* Zip:
* Name on Card: