ICMG Membership Application
Please submit the following with your $175 membership dues payment. Your membership will be activated as soon as your payment is received and eligibility verified.
(* = required field) |
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1. Membership Eligibility |
ICMG is a networking forum for developing business relationships among insurance/financial services companies. To join ICMG, you must be from one of the company types listed below or otherwise involved in the development, distribution, servicing, or business processes of insurance products. If you are not eligible for membership, please consider being an Exhibitor at our next meeting!
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Company Type*:
(Hold ctrl to select multiple) |
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| If Other, please specify: |
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2. Contact Information |
| First Name*: |
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| Middle Initial: |
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| Last Name*: |
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Nickname:
(If you go by other
than First Name) |
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| Professional Designations: |
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| Title: |
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| Company*: |
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| Street Address (line 1)*: |
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| Street Address (line 2, if needed): |
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| City*: |
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| State/Province*: |
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| Zip+4*: |
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Country:
(If non-U.S.) |
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| Phone: |
Ext. |
| Fax: |
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E-mail Address*:
(This will be your LoginID and is where
ICMG's monthly e-news will be sent) |
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| Website: |
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Choose a Password*:
(Between 4 and 25 characters) |
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| Verify Password*: |
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3. Member Profile Options |
Information you enter here will become part of your online Member Profile, where it will be
searchable by other members and printed in the Directory. Skip any fields that do not apply. |
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Products You Offer
or Are Involved With:
(Hold ctrl to select multiple) |
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| If Other, specify here: |
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Primary Insurance Activity:
(Regarding insurance products
only; otherwise skip) |
Manufacturer
Distributor
Administration
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Target Markets:
(Hold ctrl to select multiple) |
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| If Other, specify here: |
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Member Description:
(Keyword-searchable field for info
about your company, products, and
alliances sought. Must be no more
than 800 characters including spaces,
approx. 100 words - longer descriptions
will be truncated. No formatting please!) |
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4. How Did You Find Out About ICMG? |
| Please specify the name of the member who referred you, the publication you saw our ad in, the member you're replacing, or other source, if applicable. |
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5. Applicant Statement |
| By submitting this form, I hereby make application for membership in the Inter-Company Marketing Group. I understand that this application is subject to ICMG's determination of membership eligibility. |
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6. Payment Information
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ICMG Membership Dues are $175 per calendar year. If you join during the fourth quarter, your membership is effective from the time you join until the end of the next calendar year.
ICMG Dues payments are nonrefundable (except in cases of ineligibility). Membership may be transferred within the same company. |
| *Payment Option: |
Check Credit Card
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If you selected "Check," please print this page and
mail it with check to: ICMG, 44335 Premier Plaza,
Suite 125, Ashburn, VA 20147-5072. |
| Credit Card Type: |
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| Credit Card Number: |
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| Expiration Date: |
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| CVV: |
What Is CVV? |
| Cardholder's Name: |
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*Required Field |
