Utah Association of Independent Insurance Agents

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I agree that by registering for this Event, I will allow the information that I have provided in this registration form (excluding financial and disability information) as well as my image or likeness to be reproduced by IIABA or the sponsoring state association ("Sponsor") in any media, including, for example, electronic or print form, for use on web sites, or in any other publications, promotions, or presentations created by the Sponsor, in the Sponsor's sole discretion.

Buy	Qty	Description	Price
		General Partner	$1,000.00
		Bronze Partner	$2,500.00
		Silver Partner	$5,000.00
		Gold Partner	$7,500.00
		Platinum Partner	$10,000.00
		Diamond Partner	$15,000.00

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2024 UIA Partner Membership Registration