NBIPA Membership | Sponsorship form

2022-2023 MEMBERSHIP APPLICATION

Membership/Sponsorship will be valid until August 31, 2023 with this application.
Today's Date *

Month Day Year
Membership will be valid until August 31 of 2023 with this application.
New or Renewal?

New Member application Renewal of Membership
Full Name *

First Name Last Name
Industry Designation(s)
Company Name *
Company Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *

Please select your annual level of support: *

Membership Fee $ 60.00 CAD

For those wishing to be a regular member of NBIPA, vote, attend meetings, and hold office.

Associate Membership $ 40.00 CAD

For RETIRED, or OUT OF PROVINCE members wishing to stay in touch with NBIPA news and events, and attend events occasionally.

NBIPA Subscriber | Sponsorship $ 250.00 CAD

To sponsor our events and attend; gain visibility on our social platforms and website, and be mentioned at all of our events and in our communications. Sponsors also may provide educational content to be posted to our socials and website.

Total $ 0.00 CAD

Payment Methods

Credit Card

Apple Pay

Google Pay

If you have any issues completing this form, please do not hesitate to reach out to us at nbinsuranceprofessionals@gmail.com and we will be sure to assist you.

Thank you
How did you hear about us? *
Other
Suggestions for event venues, themes or topics for panel discussuions:

Would you like to refer a member? Please provide their contact information:

	Full Name	Email	Contact Number	Company
1
2

Should be Empty:

2022-2023 MEMBERSHIP APPLICATION

Payment Methods