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As an Advantage member, you are entitled to a free one-year NJYIP membership for one of your employees. Don't miss this chance to help a deserving employee develop professional skills and build a network of industry contacts.

Please fill out the form below. A NJYIP associate will contact you to finalize the membership. Advantage membership status subject to verification prior to NJYIP enrollment.

NOTE: Fields marked with and asterisk are required.

*Name
*Agency/company
*Address
*City
*State
*ZIP
Home/secondary address
City
State
ZIP
*Phone
Fax
*E-mail
*Years in insurance
*Social Security number
Insurance designation
*Date of birth
*PIANJ member number
 
*Membership level
Active I -
Less than 40 years of age
Active I -
More than 40 years of age
Associate -
Company representative
 
*Current position
CSR/clerical Principal Producer
Underwriter Marketing representative Broker
Sales manager Vendor Vice president
Other
 
*
 

 


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