Agency Membership Application

Instructions

Thank you for your interest in membership with PIA Western Alliance! Please select your agency level and then scroll down to complete the online application. If you have multiple office locations, please also select the branch option.

The top portion of the form (Individual Information) should include contact information for the primary contact person. The Business Information portion of the form should include the general contact information for the agency (if different from the Individual Information).

If you wish to pay by check, please select "Invoice Me" at the bottom of the form .

Please confirm that your contact information is accurate (with correct spelling and punctuation) prior to submitting your application. Please contact us at (888) 246-4466 if you have any questions!

Select Your Option(s)

Branch $265 Annually

Branch Memberships must have a paid Agency membership to qualify.

Agency Membership Price of Level Selected (Price Range: $515 - $915 Once Per Term)

Select Level

# of Producers	Annual Dues
1-4	$515
5-9	$590
10-14	$715
15-19	$815
20+	$915
Branches	$265 per location

Joining the PIA Western Alliance brings the power of 2 to your fingertips. What does this mean? It means your agency benefits between PIA Western Alliance Products and Services and PIA National’s as well.

PIA’s agency memberships are organizational based – meaning everyone working at your agency address is also a member!

We can assign everyone their own profile and link it to your agency’s membership. This gives everyone at your office the advantage of being recognized as a member when they log in to their account to receive discounted member pricing to our events and education.

Becoming a member of the Professional Insurance Agents (PIA) Western Alliance makes financial sense. Your membership dues are structured around legislative advocacy locally and nationally. And provides revenue generation to make your agency grow.

With the power of 2, your agency will also receive one log in to PIA National’s website. Allowing even more revenue generation and valuable industry information at your fingertips.

Did you know?

Using just one of our Revenue Generating Products or Programs would more than pay for your annual membership fee.

Plus, you receive top notch insurance products, CE educational courses, up-to-the-minute, insurance news, legislation updates, that has helped other PIA member agencies be in the know and grow.

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameBusiness Name

Please select a valid membership option and fee item if exist

Agency Membership Application

Did you know?

Thank you to our Associate Members: