Contact Natalie Simpson (nsimpson@iianc.com) with questions.

Please note: Only employees of agency/branch members are eligible to participate in IIANC's Peer Exchange Groups (dues must remain current to continue participation).
  

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* 1. First Name:

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* 2. Last Name:

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* 3. Agency:

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* 4. City:

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* 5. Phone Number:

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* 6. Email Address:

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

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* 8. Years Experience in Insurance Industry

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* 9. What is your role in the agency?

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* 10. Please mark the Peer Exchange Groups that you are interested in participating in this year.

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* 11. Are you interested in serving as a leader/facilitator for any of the following Peer Exchange Groups?

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