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Thank you for deciding to join the Michigan Professional Insurance Agents.

Please complete the following information. After you submit the form, a PayPal window will open. You will be able to pay for your membership with a Credit Card (No PayPal account is neccessary).

If you wish to pay with a check please make a note in the comments box below, disregard the PayPal window, and we can send you an invoice.

Name*
Agency/Company Name*
Phone
Agency Website*
Email*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Michigan Professional Insurance Agent Association Membership*
- Agency Membership ~ $395
- Affiliate Membership ~ (Company/Vendor) ~ $750
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