Member Plus Connect Upgrade Request

1
There is a new version of this form.

Please visit:

https://www.trustedchoice.com/advantage/upgrade-to-member-plus-connect/
2
There is a new version of this form. Please visit https://www.trustedchoice.com/advantage/upgrade-to-member-plus-connect/* This field is required.https://www.trustedchoice.com/advantage/upgrade-to-member-plus-connect/
Alabama
Arizona
Florida
Idaho
Illinois
Kentucky
Maine
Massachusetts
Michigan
Mississippi
Missouri
New Jersey
New Mexico
Ohio
Rhode Island
South Carolina
South Dakota
Tennessee
Vermont
West Virginia
I don't belong to one of these states
Select the state you have an IIABA membership with
3
Unfortunately, since your state association does not participate in the Member Plus Connect program with TrustedChoice.com, your agency does not qualify for a free Member Plus Connect profile. We invite you to checkout our Advantage subscription options located here. If you have any further concerns about Member Plus Connect, please contact your state association directly.
4
Enter the name of your agency to activate your free Member Plus Connect profile.* This field is required.
Please check the spelling so we can make sure we activate the correct agency.
5
What is your name?
First Name
Last Name
6
Enter your agency's street address* This field is required.The street address will help insure which agency to activate Member Plus Connect.
Street address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
What is your email address?* This field is required.The email you enter will be the email used to login to your TrustedChoice.com account to update your profile.
example@example.com
8
What is your phone number?* This field is required.This number will be used for your account set up of your profile.
Area Code
Phone Number
9
Select the appetite your agency offers to insurance shoppers.* This field is required.You'll be able to update your appetite even further once you're registered.
Commercial Lines Insurance
Life & Annuities
Personal Lines Insurance
10
What is your agency website URL?This will be highlighted on your new profile to help all insurance shoppers learn more about your agency.
OPTIONAL (e.g www.myagencyname.com)
11
Upload your Agency logoYour logo is prominently displayed on your new Member Plus Connect profile. If you are having a hard time uploading your logo for any reason, this can be added later.
Drag and drop files here
Select files to upload
Cancelof
12
Tell us about your agency with an 'About Us' statement* This field is required.This will be displayed at the top of your profile for insurance shoppers to see, so make it a good one.
A statement telling an insurance shopper why they should choose to work with you for their insurance needs.
0/1500
Should be Empty: