Member Join

Notice: FAIA Membership is provided on an agency/company level. If you are an individual that is request login credentials, please complete the login request form.

Agency Information

Company

*First Name

*Last Name

*Email

*Phone

*Fax

Company Email

Agency Website

Why have you decided to join FAIA?
From the following list, please type in the reason you are joining our association in the box below.

-Advocacy
-E&O
-Education
-Professional Development/Networking
-Insurance Market Access
-Member Discounts
-Referral
-TrustedChoice.com Access

*Reason for Joining

Check if you don't want your company address/contact information published in the membership directory and on the website.

Street Address

*Address 1

Address 2

Address 3

*City

State

ZipCode

Country

Preferred Mail

Preferred Bill

Preferred Ship

Please select one of the following options:

Trusted Choice^® License Agreement

*I have READ AND AGREE to the terms of the Trusted Choice® Licensing agreement.
I wish to OPT OUT of the Trusted Choice® Licensing agreement.

Agency Revenues (Gross Commissions):

*Property & Casualty Revenues:

*Life, Health & Benefits Revenues:

Lines of Business

*Personal Lines Business (% of Business)

*Commercial Lines Business (% of Business)

*Life/Health/Benefits Business (% of Business)

Employee Count

To determine the dues that state associations pay to IIABA, FAIA must provide the total number of employees, including employees at satellite locations, working in each agency. This information is held in strict confidence and will be used only by FAIA to compile the total number of individual insurance personnel employed by our members. Please use the following definition of "employees."

"Employees include all officers, owners, partners, producers, and other licensed or unlicensed employees and independent contractors who further the work of the agency or brokerage firm, wherever located in this state, whether involved with insurance, employee benefits, other financial services, or the administrative functions of the agency. Those who work 30+ hours per week should be counted as "1." Those who work under 30 hours should be counted as "1/2."

Current Employee Count

Important Notice

Contributions or gifts to the Florida Association of Insurance Agents, Inc., are not deductible as charitable contributions for federal income tax purposes. However, dues may be deductible as an ordinary and necessary business expense to the extent that they are not allocated for lobbying activities. FAIA estimates that 26.20% of your annual dues payment will be allocated to lobbying activities.

Authorization:

I consent to the receipt of e-mails and other correspondence sent to my office and additional locations from FAIA, FAIA Member Services, and IIABA and its subsidiaries. I certify that I have the authority to provide such consent, and that my agency is eligible for membership pursuant to the requirements prescribed in FAIA’s Constitution. I attest that this application is correct and that I will adhere to the FAIA’s Constitution and Bylaws.

Dues include a mandatory Government Affairs charge that is allocated to FAIA’s Political Action Committees. Dues are NON-REFUNDABLE AND NON-TRANSFERABLE. If you want the charge allocated to non-PAC advocacy efforts, contact Melissa Weaver at (850) 893-4155 ext 350.

Electronically Signed by