2012 MEMBERSHIP AND DIRECTORY APPLICATION
We are currently accepting applications for membership and directory advertisers for the 2012 Northern Illinois Adjuster’s Association. The directory is read by over 1000 people in the insurance industry each year and is a great way to advertise your company. We will also place your name and ad on our Website. A membership allows you to further professional and social contact between you and those associated with claims on a day to day basis.
We had the following information for your company last year. Please make any changes you would like for the 2012 directory on this application and return to us as soon as possible.
2012 MEMBERSHIP APPLICATION
Name ____________________________________________________________
Title ____________________________________________________________
Firm __________________________Phone # _________________
Mailing Address ____________________________________________________
Email Address ______________________________________________________
D I R E C T O R Y A D S
$ 55.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/4 Page [ ]
2 x 4 ¾
$ 85.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ……………… . . . . 1/2 Page [ ]
4 ¾ x 3 ¾
$140.00 . . . . . . . . . . . . . . . . . . . . . . . . . ……………….. . . . . . . . . .Full Page [ ]
7 ¾ x 4 ¾
$200.00. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . Divider [ ]
7 ¾ x 4 ¾
*SEALED BID . . . . . . . . . . . . . . . . . . Inside Front Cover [ ]
*SEALED BID . . . . . . . . . . . . . . . . . . Inside Back Cover [ ]
*SEALED BID . . . . . . . . . . . . . . . . . Outside Back Cover [ ]
$100.00 COMPANY MEMBERSHIP [ ]
$20.00 INDIVIDUAL MEMBERSHIP [ ]
Sealed bids must be more than $200.00.
Please send a copy of your ad along with your ad on a disk to NIAA only if you plan to make changes from last years directory.
MEMBERSHIP AND AD PAYMENTS MUST BE RECEIVED BY THURSDAY December 1st.
Current Member Recommendation Signature
Your signature _____________________________________________________
Date: _____________________
Date Received _______________________
Date Accepted by Board _____________________________________________
Your membership becomes effective when your dues have been received.
Forward your application and payment made out to NIAA to:
NIAA P.O. Box 1774 Rockford, IL 61110
