Application for Membership of IMIA

Before you fill in this form, please be aware of the IMIA Articles and Charter, 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 to the Articles of Association
*Do you also agree to pay an initial membership fee levied in accordance with the fees shown on the Members web and thereafter to pay the membership fee annually in advance.
*Subject to your application being successful, you authorise us to enter your name in the Company’s register of Members.
*If your application is successful, does your organisation agree to abide by IMIA's Charter
* If your application is successful do you intend to send a delegate to IMIA's annual conferences?