|
Board of Directors |
|
Applying For: |
IIABNY Board Member
IAAC Board Member
Executive Committee
State National Director
Nominating Committee Member
|
|
* Name: |
|
|
Designations: |
|
|
* Email: |
|
|
Cell Phone: |
|
|
* Agency Name: |
|
|
Agency Position: |
|
|
Agency Owner: |
Yes
No |
|
Business Address Line 1: |
|
|
Business Address Line 2: |
|
|
Business City: |
|
|
Business State: |
|
|
Business Zip: |
|
|
Business County: |
|
|
* Business Phone: |
|
|
Business Fax: |
|
|
Home Address Line 1: |
|
|
Home Address Line 2: |
|
|
Home City: |
|
|
Home State: |
|
|
Home Zip: |
|
|
Home Phone: |
|
|
Local Newspaper Contact Info: |
|
|
Local Association Affiliation: |
|
|
Other Insurance Organizations: |
|
Previous Offices Held:
(include year) |
Local Association
State Association
National Association
|
|
Education (College, Insurance, Designations): |
|
|
Insurance Experience and Information: |
|
|
Insurance Company Advisory Boards: |
|
|
Insurance Association Activities (Local, State, National): |
|
|
Community and Civic Activities: |
|
|
Additional Remarks: |
|
|
To submit a resume or additional information, please email them as attachments to Kathy Weinheimer at kweinheimer@iiabny.org. |
|
Submitted By: |
|
|
Phone: |
|
|
|
|
|
