Application for Membership of IMIA

NOTE:
Before you fill in this form, please be aware of the Constitution of IMIA, the Fees payable by members and the Roles and Opportunities of Members.

* Name of organisation
* Address of head office
* Website address
* Grade of membership being applied for (National Association, Reinsurer, Insurer, Associate (e.g. Loss Adjuster, Broker, Lawyer, Expert)
* Number of employees /members in your organisation approximately
* Number of senior employees/individuals involved in engineering insurance
* Locations of offices involved in engineering insurance (countries if applicable)
* Please explain how you consider your organisation would contribute to IMIA's goals
If your application is successful who will be the main contact?
* Name
* Job title/Qualifications
* Address
* e-mail address
* Telephone number
* If your application is successful, does your organisation agree to abide by IMIA's constitution
* If your application is successful do you intend to send a delegate to IMIA's annual conferences?