Membership Request

Membership Request

If your company is already a member you can Request a User Account

Membership in the Insurance Tax Conference is available to any firm that is involved in the insurance tax industry. Each firm member is entitled to list individuals in the membership directory. Only representatives from member companies may register to participate in the conference. The current membership fee is $200 per organization per year. The membership fee is subject to change and will be confirmed at the time of purchase.

Personal Information

Prefix
First Name
Middle Name
Last Name
Suffix
Title
Designation
Individual Type
Organization Name

 

Parental Consent

As per GDPR compliance requirements, association staff may reach out to the guardian listed in the Name and Contact Information fields above. Please provide a contact number and/or email address where your guardian may be reached.

Parent/Guardian Name
Parent/Guardian Phone
Parent/Guardian E-Mail

 

Address Information

Please select your country first and the “State” input field will be populated with available states, provinces or territories of your country.

Work Address
Address 2
City
State
Zip
Country

 

Contact Information

A primary e-mail address is required for using this web site. It will be used as the login ID to be able to log in to the site. Passwords must be 8-32 characters, one upper case letter, one lower case letter, one number AND one special character ($,!,#,@,&).

Email
Desired Password
Work Phone
Mobile Phone
Work Fax
Website

 

Please provide the following additional information

Professional Designation
License Type
Expertise

 

Contact and Publishing Preferences

Please let us know how you would like to be contacted and if you would like your information to published online.


Billing Information

First Name
Last Name
Address
City
State
Zip