Membership Application | Big I Maryland

Associate Membership Application

Associate Membership is open to any individual, company, vendor, or other entity affiliated with the insurance industry that does not meet the eligibility requirements for regular agency membership may apply for associate membership. Associate Members have no voting rights, cannot serve on the Big I Maryland Board of Directors, and does not receive membership in our nation association (Big I).

Associate Membership costs $500 and includes the following benefits:

- Subscription to our quarterly magazine (Maryland Messenger) as well as other Big I Maryland communications
- Regular updates on key insurance issues during the legislative session
- Member rates for all events and CE seminars sponsored by Big I Maryland
- Member rates for advertising in the Maryland Messenger

ASSOCIATE MEMBERSHIP

Membership Dues

Organization Code

Enter the organizational code provided by your organization.
This connects your account to your organization's Big I Maryland membership.

Your Dues Rate Type is: Associate Member $500.00

Add-On Password

Create a password your employees can use to link their individual accounts to your organization's Big I Maryland membership. Share this password with your team so they can register under your agency.

Contact Information

Email *

Re-enter your email *

First Name *

Last Name *

Title

Company *

Address Line 1 *

Address Line 2

City *

State

Zip Code *

Website

Logo

Phone Number *

Fax Number

CCMail

Include me in Membership Directories *
Yes No

Username/Password Username/Password

Please enter the Username/Password you would like to use to login to this website.

Your Username must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Username *

Password *

Confirm Password *

Additional Information

Business Description: *

Payment Details

Payment Method

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Account Type

Checking

Savings

Routing Number

Account Number

Account Holder Type

Business

Personal

Business Name

Account Holder Name

By submitting payment, I am authorizing Big I Maryland to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Big I Maryland, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.

Name on Card

Card Number

Expiration

CSC

Billing Street

Billing Zip Code

PO #

Save payment method for future purchases

Due Today

Surcharge

Total Amount Due

SURCHARGE: Please note, there is a 3% surcharge on all credit card payments and a $2.00 surcharge on all eCheck payments.

Please Note: All membership dues are non-refundable.

If you have questions regarding associate membership dues, please reach out to Kyrsten langford at kyrsten@BigIMD.com or 410-766-0600.

Associate Membership Application

Membership Dues

Contact Information Contact Information

Username/Password Username/Password

Additional Information Additional Information

Payment Details Payment Details

Contact Information

Additional Information

Payment Details