Program Administrator Membership Application

Program Administrator Membership

Requirements for membership: Administration of one program with binding authority and minimum annual gross premium revenue of $1MM.

All information will be treated as confidential. No specific details regarding your program will be released to anyone without your prior authorization.

Total Amount
Applicant Information
To ensure your application submits correctly, please avoid pasting any text with formatting (such as bold, italics, or special fonts). We recommend copying text only from plain text documents like Notepad, which removes any unwanted formatting.
 
Include contact name, company, email, and phone.

Program Data

Program Administrator History

Please provide a brief explanation of the PA's carrier changes in the past 10 years.

 
 
 
 
 
 
 

Involvement in Target Markets

 
By submitting this application: 1) The applicant attests that all information in the application is correct. 2) The applicant will abide by the Association Bylaws as they may be amended from time to time. 3) The applicant is not aware of any reason why the Bylaws cannot be observed. 4) The applicant agrees to comply with the TMPAA Code of Conduct.
Account
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Primary Contact
Payment Options
 
[x] Payment due upon approval.

Additional Individuals Actively Participating in the Association

First Name Last Name Email
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Sustaining Partners