Partner Application
Select An Option
Affinity Partner
$600 Annually
Non-insurance businesses are eligible to be Affinity Partners
Associate Partner
$750 Annually
Industry Partner - Bronze
$2000 Annually
Industry Partner - Silver
$3000 Annually
Industry Partner - Gold
$5500 Annually
Industry Partner - Platinum
$8000 Annually
Industry Partner - Diamond
$12500 Annually
NIIA Industry Partner - Diamond
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Prefix (i.e. Mr. Mrs. Dr.)
First Name
Last Name
Suffix (i.e Jr. Sr. III)
Designations
CRIS
CLU
LUTCF
CIC
CISR
RPLU
CRM
ARM
ALCM
ACSR
CPCU
CPC
ChFC
E-mail
Family Name
Business Name
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