Rocky Mountain Association of Public Insurance Adjusters
RMAPIA

(Serving the States of Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming)

 

Type of Application: (*)
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(A Regular Member has all the rights and privileges of the Association including voting) (An Associate Member is a member of a firm of the Regular Member) (An Affiliate Member is a part of the Adjusting Community sharing in our values)

ANSWER ALL ITEMS FULLY.* denotes a required field
The applicant understands and agrees that the submission of an application for membership in RMAPIA by e-mail or facsimile shall be considered and will constitute a signed application

First Name (*):
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Last Name (*):
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Firm name (*):
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Business Address (*):
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Email (*): Imput a valid Email or This Email already exists.
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Residence Address:
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Residence Phone:
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Please check to which address you wish mail sent:
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Number of Members in Firm:
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Type of Business:
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How long have you been associated with your current firm?
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Years in P.A. Profession: (*):
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Are you now licensed as a Public Adjuster?
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If so, State you are licensed for*:






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Are you engaged as a Public Adjuster exclusively on a full-time and professional basis?
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Are you engaged in any business other than public adjusting? If so, describe: (*)
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Are you engaged in any way in building construction or fire damage restoration? If so, describe: (*)
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Have you ever been reprimanded or disciplined by any Insurance Department or other government agency? If answer is yes, furnish full particulars. (*)
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Has your Public Adjuster's license ever been suspended or revoked? If yes, furnish full particulars (*)
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Have you ever adjusted any third party claims? If yes, furnish full particulars. (*)
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Does your firm maintain an E & O insurance policy?
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REFERENCES

:Give three business references: (Include complete addresses and phone numbers to facilitate reference checks).
Reference 1 (*)
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Reference 2 (*)
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Reference 3 (*)
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Security CodeSecurity Code  Refresh
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NEW MEMBER FEE $200

Paid once by a New Member's Company. This covers the costs of processing and registration for everyone in a Company for which a person will become a member.

ANNUAL DUES: $200.00 Regular members and Associates $750.00 Affiliate

Contact us for special rates for groups of five or more.

Member's Agreement and Release:

Consistent with my desire to participate in the Rocky Mountain Association of Public Insurance Adjusters, I assert that I am personally responsible for my conduct, individually and as a member of a RMAPIA. I agree to abide by the Code of Ethics of the Association and will refrain from any form of discrimination, harassment,derogatory, illegal, or unethical conduct.
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• Abide by the Association's Standards of Conduct.

• To maintain honest and ethical standards as promulgated by the Association, The Standards of Care in the Industry, Slate and local laws and Regulations.

• To help the Association maintain the positive, friendly environment necessary for all members to learn and grow.

• To treat my fellow association members and our guests with respect and courtesy.
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