Associate Membership Application - Independent Insurance Agents of New Mexico

Unlock the benefits that only members receive!
We have two levels of Associate membership available:

Associate Membership ($500 Annually)

Listing in our online and print member directory
Access to our online and print member directory
Member pricing to all events and education
Keep up to date with all communications
Invitation to Networking events with owners of over 125 insurance agencies in the state
$200 discount on booth at premier Trade Show (Member price: $720)

Associate Plus Membership ($1,000 Annually)

(everything from above)
Included booth at premier trade show

Associate Member Application

Please contact rachel@iianm.org if you have any questions.
Company Name:
Main Contact:

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Company Website:

If there is anyone else in your company who would be interested in receiving our member communications, please include their information below.

If there is no one, please click NEXT.

Additional Company Rep 1
Name

First Name Last Name
Email
example@example.com

Additional Company Rep 2
Name

First Name Last Name
Email
example@example.com

Additional Company Rep 3
Name

First Name Last Name
Email
example@example.com

Additional Company Rep 4
Name

First Name Last Name
Email
example@example.com

Additional Company Rep 5
Name

First Name Last Name
Email
example@example.com

Signature

Clear
Dues Pricing Information
We have two levels of Associate membership available:

Associate Membership ($500/Annually) Associate Plus Membership ($1,000/Annually)
(After clicking the "SUBMIT" button, please select the "PayNow" button to submit dues payment.)
Should be Empty: