Broker Membership Form

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Broker Membership Form

AIRMIC (The Association of Insurance and Risk Managers) has 850 members and represents the buyers and risk managers of about 75% of the UK FTSE-100 group of companies, as well as very substantial representation in the FTSE-250 and other smaller companies.

If you wish to apply to become a member, please complete the below form and then click 'Submit Application' at the bottom of the page to send it to us. Your application will then be assessed, once approved, we will contact you within 2 days requesting payment. A form needs to be completed for every applicant applying.

If you have any problems completing the form, please contact the Membership Coordinator, Robert Coleman on: 020 7680 3085 or at: robert.coleman@airmic.co.uk

Join AIRMIC

Title:
Your Name: *
Company Name: *
Nature Of Business
Current Position: *
Business Address: *
Town: *
Postcode: *
Country: (if not UK)
Telephone Number: *
Email Address: *
Mobile Number
Personal Email Address
(please supply so we can keep in touch with you if you leave your current company)
What Responsibility Do You Hold Within Your Company?
Do you provide insurance and/or risk management services outside your Employer's group? *
- Yes
- No
Source of Introduction
Who is your broker? *
From time to time AIRMIC uses third parties to undertake projects, surveys and member communications. This involves passing your contact information to such third parties. We will not use this information for marketing purposes.
Please check the following box if you do not wish to participate in these projects

Airmic

Broker Membership Form

Do you provide insurance and/or risk management services outside your Employer's group? *

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