Thank you for your interest in becoming more involved with IA&B. Please complete this form in its entirety.

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Please contact me about (check all that apply): * participating in a Member Agent Panel the Futures Program (agents under 40) serving on my state's Government Relations Committee participating in state grassroots events participating in federal grassroots events serving as a Director on the IA&B Board serving on the PA JUA board serving on the PA Underground Storage Tank Fund Board serving on the PA Assigned Risk Plan Governing Committee contributing to AgentPAC
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