Independent Insurance Agents of Maryland, Inc.  

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Application for Membership

IIAM Association dues are deductible by members under provisions of the Internal
Revenue Code as business expense.  This does not include a specific percentage used
in IIAM's lobbying activities.  Dues are not deductible as charitable contributions for Federal Income Tax purposes.
                                                                                                          
Dues Structure  
Dues in the Independent Insurance Agents of Maryland are based on total annual premium volume which the agency generates from all sources.  Your total annual premiumvolume establishes your annual dues according to the formula below.  A check to the order of IIAM, coveringa full years' dues must accompany the application.
$0-$500,000
$375.00
$500,001-$1,000,000
$500.00
$1,000,001-$2,000,000 $650.00
$2,000,001-$3,000,000
$825.00
$3,000,001-$5,000,000
$1075.00
$5,000,001 and over
$1325.00
Life/Health Agents
Membership to State/Local ONLY...not National Association		 $400.00
Retiree (Prior Members upon Retirement) $100.00

Note:  If paying by credit card, please fax application to 410-766-0993

Agency Name:
T/A
Street Address
CityStateZip
TelephoneFaxE-mail
Please print or type name(s) of Principal(s) and List Designations:
Principal #1
SS#Position
Principal #2
SS#Position
Principal #3
SS#Position
I/We represent the following companies
Company #1
Company #2
Company #3
Actual Agency Locationif other than street address
Check One:    Individual    Partner     Corporation     LLC              
# Agency Principals:No. Licensed ProducersNo. Other Employees
Branch officesw/identical ownership
We are members of:     PIA    CPCU Society    CIC Soceity       Other
Agency Website AddressDo you wish to be linked to IIAM's site:  Yes     No
Do you have a personal contact in Congress? Yes    No    State Legislature?    Yes    No
Please list the Property/Casualty insurance companies which account for at least 85% of your total premium volume.
Company % Company %
Company % Company %
Please indicate %- Personal LinesCommercial LinesLife/HealthOther
Other business interests:

I/We herby apply for corporate membership in the Independent Insurance Agents of Maryland subject to the provisions of its Charter and By-Laws.   I/We understand that membership in the IIAM local association in my area is also a requirement.  Please click here for a copy of the Local Association Agreement!
I/We understand that the purpose and object of this Association are to disseminate reliable information relating to the business in which its members are engaged:  to advocate and support right principles and practices and to oppose bad ones in the transaction of the business of insurance and generally to advance in every legitimate way the business in which the members are engaged.
I/We agree, if elected to membership, to faithfully abide by the By-Laws of the Association and all amendments thereto; all rulings of the Board of Directors, and all resolutions duly adopted by the Association and to faithfully carry out the intent as well as the purpose of the Code of Ethics of the Independent Insurance Agents of America (which I understand I become a member of IIAA, when accepted by IIAM) and the Insurance Laws of the State of Maryland.
Name:_______________________________________________________
Title:________________________________________________________
Please mail application & local application and Payment to:
Independent Insurance Agents of Maryland, Inc.
2408 Peppermill Drive, Suite A
Glen Burnie, MD.  21061

DUES ARE NON-REFUNDABLE
If you have any questions regarding membership or this application, please notify Shelley at iiamarnold@aol.com