Protect Association

Protect Association Membership Application Form

Online Form

Company / Individual Name:

Main Contact Name (if company membership):

Job Title

Email:

Phone:

Please give a brief summary of your UK Insurance market interest/activity?

Opt-In

By checking, I agree to share my form responses.

Membership applied for (please delete one):

Individual £175

Company £455

Note: both cover 12 months membership, and we are not VAT registered

Agreed

Disagreed

Payment methods: Select ONE

Via BACS transfer to - Account name – Protect Association Lloyds Bank Sort code- 30-96-00 Account number - 03127359

We will email you an invoice

Through PayPay to payments@protect-aci.org.uk

Payment terms: Please include individual / company name in your payment reference We will send you a receipt/invoice in respect of your payment. Please supply a contact name and billing address we should send the invoice to, if it’s not, the address, or individual named above.