IBAH | New Member Application

Submit Your Application Online

To submit your application online and pay using a credit card through our secure payment portal, please complete the form on this page.

Once you click 'submit', you will be redirected to our online payment portal, where you will have the option to pay by VISA, MASTERCARD or AMERICAN EXPRESS.

> I'VE ALREADY COMPLETED THE FORM. TAKE ME DIRECTLY TO THE ONLINE PAYMENT!

Prefer to Use Paper?

No problem! Mail your completed application, along with your cheque to:

Chad Brownlee, Membership Chairperson, c/o Dan Lawrie Insurance Brokers, 105 Main Street East, Suite 14th Floor Hamilton, ON, L8N 1G6

Questions? Contact Chad at (905) 525-7259 x1364

> DOWNLOAD IBAH NEW MEMBER APPLICATION

Apply for IBAH Membership

Company Name: *

Street Address: *

City: *

Postal Code: *

Company Website: *

Company Phone: *

Company Fax: *

Contact Name: *

Contact Email Address: *

# Total Staff: *

# RIBO Licenced: *

# Unlicenced: *

What type of membership? *

Member

Associate Member

How are you paying? *

Online

Cheque (Mail in)

Upload company logo (high resolution):

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