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Membership Application/Invoice
September 1, 2009 - August 31, 2010
 
Article III, Membership.
Section 1. Regular Membership: Any licensed insurance agent of good standing within the State of Ohio, representing any auto, fire, life, or multiple-line insurance company, who is not an employee of said insurance company, may upon the recommendation of two regular members, be eligible for voting membership.

Section 2. Affiliate Membership: Any employee of any insurance company represented by any regular member agency, or any individual who renders a general product or service to the general insurance industry, shall be eligible for Affiliate non-noting membership.
 
Dues Structure:
$225.00 (Minimum) for the agency/organization, including one individual.
$225.00 for the second individual and each subsequent individual up to, $1,350 Maximum for any organization
$50 Annual Fee to include Affiliate Web Address and link on IBNO Web Site
 
(4 dinners and 4 lunches are included at NO COST with each individual membership. Large organizations that pay the maximum dues option are entitled to 24 lunches and 24 dinners at NO COST throughout the year.)
 
Please complete the following for membership in the Insurance Board of Northern Ohio
All information will be held in strict confidence.
MEMBERSHIP TYPE
(* denotes required field)
Regular   *
Affiliate  
COMPANY INFORMATION
Agency/Organization:
 *
Principal Contact:
 *
Street Address:
 *
P.O. Box/Suite:
City:
 *
Zip Code + 4:
 *
Phone:
Fax:
E-Mail:
Web Site:
 
check here if you want a link placed on the IBNO web site to the above web site
(Limited to Affiliate Members only -- additional $50 annual fee applies)
 
Branch Offices (Agencies Only):
EMPLOYEES/INDIVIDUALS
List Affiliate Employees/Licensed Individuals: Include principals, producers, and other licensed personnel
  Name E-mail Address Annual Dues
1) * $225
2) $450
3) $675
4) $900
5) $1,125
6) $1,350
7) -----
8) -----
9) -----
10) -----
11) -----
12) -----
13) -----
14) -----
15) -----
   
Membership Annual Dues:
*
   
+ $50 Annual Web Site Link Fee:
   
TOTAL Annual Fees:
       
PAYMENT INFORMATION
Check MasterCard VISA Discover American Express *
Card Number:
Expiration Date:
Name on Card:
Billing Address:
P.O. Box/Suite:
City:
State:
Zip:
OTHER MEMBERSHIPS
IIAO PIA Other