Associate Membership Application

Instructions

Thank you for your interest in an Associate Membership with PIA Western Alliance!

Please select your Associate Membership level and then scroll down to complete the online application.

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 company (if different from the Individual Information). Please select the state(s) you represent that corresponds with the number of states from your membership level from the dropdown menu.

Please review and confirm that your contact information is accurate prior to submitting your application. Once application is received, we will review and contact you if there are questions. When approved, your credit card will be charged and you will receive a confirmation email and receipt. If you wish to pay by check, please select "Invoice Me" at the bottom of the form .

Please contact us at (888) 246-4466 if you have any questions!

Select Your Option(s)

Associate Membership Price of Level Selected (Price Range: $500 - $2750 Annually)

Select Level

If you are a vendor or carrier that would like to consider being part of the Western Alliance, an Associate Membership means we work with you and for you to provide your company with additional marketing exposure to the retail agent community in the 10 western states we serve.

The Western Alliance has spent the better part of the past year working on new Affiliate Agreements with PIA National. These new agreements will allow each of the 10 Western Alliance states more individual identity to better align your company in the states you do business.

Your approved logo and social media messaging can reach our agency membership base in several ways, while providing additional value in partnership. There are a variety of benefits and exposure opportunities available to you as an Associate Member. Member dues are annual.

Here are just a few of the Associate Member Benefits:

Associates showcased on state(s) they want a presence in on PIAWEST.COM state pages.
One introductory post on our social media channels when your membership begins or renews.
One free PIA hosted webinar for CE. Share with your best agent or colleague.
Member pricing discounts for Continuing Education with PIA.
Reduced member pricing for exhibiting or attending PIA Western Alliance annual conferences.
Host 1 of your best agents to a state or regional Western Alliance event.

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

Associate Membership Application

Thank you to our Associate Members:

Professional Insurance Agents Western Alliance

4400 NE 77th Ave., STE 330
Vancouver, WA 98662
(360) 571-7100 (888) 246-4466