Introduction to Protection & Indemnity Insurance Registration Information

Introduction to Protection and Indemnity Insurance Registration Information

Print out the following page and either mail it in with a check payable to American Institute of Marine Underwriters, 14 Wall Street, New York, NY or fax with Credit Card Information filled in below to fax number: (212) 227-5102.


First Name:
Last Name:
Title:
Company:
Business Address:
City:
State:
Zip Code:
Telephone:
Fax:
Email Address:
License #:
(Last 4 digits of your SS# is needed for New York - this can be given at the course)

Tuition is $300.00 per student for AIMU Members Tuition is $450.00 per student for AIMU Members Agents & Brokers Tuition is $600.00 per student for Non-Members of AIMU
Number of Participants:
Total Fee Paid:
Method of Payment
Check: Please make payable to: American Institute of Marine Underwriters (please note student's name and course on check stub)
Credit Card (Circle One) MasterCard AMEX Visa Diners

Cardholder Information
First Name:
Last Name:
Card Number:
Exp. Date: