Corporate Associate membership application

Instructions

Application for Corporate Associate membership of the Independent Insurance Agents & Brokers of SC. When submitting your application you will be required to provide payment and will be charged upon submission and approval.

Membership fees include a voluntary contribution to the IIABSC Foundation. Learn more at iiabsc.com/foundation.

Select An Option

Affiliate Price of Level Selected (Price Range: $750 - $14000 Annually)

Select Level

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameBusiness Name

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