Action Alert - Contact Your Legislators Today and urge their support H.3682

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MAIA Membership Application
Membership in MAIA is open to independent, licensed insurance agencies doing business as individuals, partnerships, corporations or other forms of business organizations operating within and subscribing to the principles, aims and objectives of the American Agency System or required to do business with a non-agency company under a state-created insurance program.
Name of Owner:
Agency Name:
Mailing Address:
City, State, Zip:
  What type of business organization is your agency?
(Please check one box)

Sole Proprietorship
Please call
Sheron Gagnon
at 508.634.7378
for prorated dues.
Dues for MAIA are based on the number of personnel working in your agency. For the 2017 Association year, dues are as follows:
For the purpose of determining the proper dues category, "agency personnel" includes owners, principals, solicitors, producers (whether salaried or paid by commission), in-house brokers, CSRs, clerk-typists and other office support staff who work twenty (20) hours per week or more.
1-2   employees $575.00
3-5   employees $680.00
6-7   employees $820.00
8-9   employees $995.00
10-15   employees $1,215.00
16-20   employees $1,550.00
21-25   employees $2,180.00
26-30   employees $2,780.00
over 30   employees $3,630.00

Please type in the total number of staff in all agency locations:

  Please check the box:
I attest that I have not knowingly misrepresented any of the information provided on this application.

Please type your name & position in the agency:
Thank you for your support!