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* 1. Please mark the committee(s) that you would be interested in serving in September 2018 - August 2019

  First Choice Second Choice Third Choice
Personal Lines Committee
Commercial Lines Committee
Governmental Affairs Committee
Agency Management and Technology Committee
Membership Committee
Professional Development Committee
Employee Benefits Committee

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* 2. Learn more about IIAG Committees:
Click here to learn more about each of IIAG's Committees

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* 3. Name

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* 4. Agency/Company:

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* 5. City:

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* 6. Phone Number:

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* 7. Email Address:

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* 8. Date of Birth (MM/DD/YY):

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* 9. Years Experience in Insurance Industry:

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* 10. What is your role in the agency/company?

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* 11. Please share any other comments or information that should be considered when making committee appointments for 2018-19.

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* 12. Learn more about IIAG Committees:
Click here to learn more about each of IIAG's Committees

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