LAAIA of Broward County
United We Serve as a Voice for Independent Insurance Agents

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Sponsorship Application

LAAIA hosts 6 monthly meetings in Broward with average attendance between 40 to 60 agents and agencies representatives. Annual sponsorships include attendance at up to 6 monthly meetings per 12 month period. Sponsorships will not be rolled over unless BLAAIA fails to host at least 6 meetings.

Applicant Information
Company Name: *
Representative Name: *
Address Street 1: *
Address Street 2:
City: *
State: *
Zip Code: *	(5 digits)
Daytime Phone: *
Fax: *
Email: *
Additional Representatives
Full Name:
Full Name:
Sponsorship
Type: *
Fee: *
Event Date:	(For Individual event Sponsors Only)
Other Information
Comments:	Enter comments here!
	I/ We authorize the above information is true and accurate and that we accept all of the constitution of the Broward LAAIA.