Membership Application

Note before completing this form, please be aware of the constitution of IMIA, the fees payable by members and the Roles and Opportunities of members.

Membership Application Form (23/24)

Name of organisation
First Name*
Last Name*
Work Email*
Address of head office
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Website
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
Location of offices involved in engineering insurance
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
First Last
Job Title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
If your application is successful does your organisation agree to abide to the Articles of Association and the IMIA Charter, In particular do you agree to guarantee the debts of the Company up to a maximum of £1 if the Company is wound up while you are a member
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 constitution?
If your application is successful do you intend to send a delegate to IMIA's annual conference?