Legislative & Regulatory Council Volunteer Form


*Required Field

General Information
*Name:
*Agency:
Member Id:  
Job Title/Position:
Mailing Address:
City:
Zip:
*Phone:
Fax:
*Email:


Experience
*Years of Experience in Insurance Industry:  
*Describe any experience you have in the political, regulatory, or legislative arenas:
  Code of Ethics for FAIA Volunteer Governance