Membership Application


Membership Investment

Active 1 - First member from each agency $495.00 includes your National Association dues. Active 1 membership is limited to agency owners, principals, or licensed producers engaged in full-time production of insurance. Voting Privileges.

Active 2 - Additional licensed agency personnel $75.00 Voting Privileges.

Active 3 - Includes company personnel (sales, claims, underwriting) and third party vendors (glass companies, etc.) $250.00 first member, each additional $50.00

Associate Members - Non-licensed agency personnel $75.00 Non-Voting Privileges.

Membership application Form
Username:
Password:
Membership Type:
Title  (i.e Mr. Mrs.)
First Name:
Last Name:
Middle Initial
Nick Name
Designations:
Company:
Mailing Address:
Street Address:
City:
State:
Zip Code:
County:
Personal Telephone:
Office Telephone:
Fax Number:
Toll Free Number:
Email Address:
Web Address:
Agency Established Date: (ex. 1990)
Number of Employees:
About Our Agency:
Insurances: AutoBusinessHealthHomeLife

I have read and agree with the terms and conditions

    

 

Professional Insurance Agents of Kentucky
107 Consumer Lane
Frankfort Kentucky, 40601
Phone: 502-875-3888   *   Fax: 502-227-0839