Forum Dues Application
Fill out the form below and press the Submit button at the bottom of the form. This will email the information entered on the form to AMIF Membership Director, Kristine Tennyson, If Paying by Check, indicate the check number and press Submit to display your registration receipt and the address where checks should be sent. If Paying by PayPal press the Submit button after filling in the fields below to display the PayPal payment form.
Fill out the form below and press the Submit button at the bottom of the form.
This will email the information entered on the form to AMIF Membership Director, Kristine Tennyson,
If Paying by Check, indicate the check number and press Submit to display your registration receipt and the address where checks should be sent.
If Paying by PayPal press the Submit button after filling in the fields below to display the PayPal payment form.
Membership Fee
Last Name
First Name
Company
Title
Company Street Address
Company City, State, Zip
Business Phone
Business Fax
Email
Date of Birth
Date Started in Industry
Payment Method
Company Check
Check Number
For more information contact: Kristine Tennyson Chartis 32 Old Slip 19th Floor New York, NY 10005 Direct Phone: (646) 857-1272 Kristine.Tennyson@Chartisinsurance.com
