If your organization would like to join Americans for Insurance Reform, please fill
out the form below and mail it to:
Attention: Daniel Albanese
Americans for Insurance Reform
P.O. Box 3326 Church Street Station
New York, NY 10008
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We are a non-profit group and would like to join the Americans for Insurance Reform Coalition. Please sign us up:
____________________________________________
(Organization name)
endorses and supports the mission of Americans for Insurance Reform to reform the insurance industry and authorizes Americans for Insurance Reform to mention this endorsement in connection with its activities. Americans for Insurance Reform agrees to keep the above-mentioned organization informed of its activities.
______________________________________________________________
(Signature) (Title) (Date)
Name ___________________________________________________________
Title ____________________________________________________________
Organization _____________________________________________________
Address _________________________________________________________
________________________________________________________________
Phone ________________ Fax ________________ E-mail _________________
Please check all that are applicable:
__ We want to learn more about AIR and how we can become more involved. Let us know how we can support grassroots AIR activities in our area.
___ We would like to be kept informed about federal legislation and would consider signing onto letters to lawmakers in support of or opposition to specific legislation. We understand that our name will not be used on any lobbying materials without prior review and consent.
Optional: If yours is a membership organization, how many members do you have? _______
PLEASE MAIL THIS SHEET TO: Americans for Insurance Reform; Attention: Daniel Albanese; P.O. Box 3326 Church Street Station, New York, NY 10008.
THANK YOU!