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New York City Association of Insurance Women Membership Application and Renewal Form
Please complete following information
First Name
*
Last Name
*
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Company:
*
Position:
*
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Mailing Address
*
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Work Phone
*
Cell Phone
*
Email Address
*
Type of Experience/Number of Years in the Insurance Industry:
“Would you be interested in volunteering for any NYCAIW committees in the future? If so, what area(s) would be of most interest to you?
Budget & Finance
Community Affairs & Public Relations
Education
Membership/Organization
Programs
Do you have prior experience service as a Board Member for other non-profit organizations:
*
Yes
No
How did you hear about us?
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Membership Fees: $100
Renewal Fees: $100
Please enter 1 in box below.
Membership Fees
Student Membership Fees: $50.00
Renewal Fees: $50
Please enter 1 in box below.
Membership Fees
You will have the option of using Paypal or credit card once you are at PayPal site.