C.E., DUES & DONATION PAYMENTS Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.SelectC.E. Six (6) HoursMembershipDonationsC.E. Study Materal/Affidavit/Access to TestPrice: $ 110.00Available Items *Voting Membership Dues – $ 110.00Supervising Membership – $ 400.00Non-Voting Membership – $ 50.00Donation – $ 0.00FREE CONTINUING EDUCATION IS NOT INCLUDED WITH NON-VOTING ASSOCIATE MEMBERSHIPS.DonationEnter Amount You Wish to DonateTotal Amount$ 0.00Individual (voting) Membership dues shall be One Hundred and Fifty dollars ($150.00) per two year, per member unless changed by the members. Dues shall be payable biennially with the first renewal on January 1st of even years and shall be paid within 30 days of statement date unless such period is lengthened by the membership. Supervising (voting) Membership dues shall be Four Hundred Dollars ($400.00) per two year, per member unless changed by the members. Dues shall be payable biennially with the first renewal on January 1st of even years and shall be paid within 30 days of statement date unless such period is lengthened by the membership. Associate (non-voting) Membership shall be Fifty Dollars ($50.00) per two year per person. Dues shall be payable biennially with the first renewal on January 1st of even years and shall be paid within 30 days of statement date unless such period is lengthened by the membership. “Supervising Agency” shall be defined as an insurer or an employee, person, or agency that is an indemnifying agent or other entity that owns or controls a Build-Up-Fund, a record of which is on file with the Indiana Department of Insurance, and that supervises, manages and/or oversees one or more sub-agent(s) that report directly to that agent, agency, insured, employee or person. Name *FirstLastEmail *Company Name *Additional Agent One *FirstLastAdditional Agent Two *FirstLastPhone *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDateStripe Credit Card *CardName on CardComment or MessageSubmit
