Florida's Future Insurance Leaders Application

Florida’s Future Insurance Leaders is a leadership immersion program designed to attract high caliber agents and help them develop through education and mentorship to become future leaders in the insurance industry and their community.

Read More About Criteria for Admission and FFIL Program Sessions

Please fill in the information requested below. Fields with an * are required.
*Sponsor's Name/Agency:  
*Candidate's Name:  
*FAIA Member ID  
*Agency City/Branch  
*Candidate Phone  
*Candidate Email    
*Insurance License Number:  
*Current Community Service:  
*Business Affiliations:  
*Other leadership training courses taken, course name(s), and dates taken:
*Why do you want to be in the FFIL program?:  
I understand that I am required to attend all events (Legislative Fly-In, Convention, and Planning Session) and programs to graduate from the FFIL program. Though FAIA waives event registration fees for FFIL students, I understand that I am responsible for travel and lodging expenses.
*Mentor Name  
*Mentor Email    
*Candidate Electronic Signature  
*Mentor Electronic Signature  
*Attach Resume or CV  
 
*Letter of commitment signed by the applicant and his or her agency principal;  
 
Credit Card Information
*Credit Card:
*Credit Card Number:               
*CVV Code:  
*Expiration Date (mm/yy):  
*Billing Address:  
*Billing City:  
*Billing State:
*Billing Zip:  
*Name On Card:  
Submit