Membership Form

New Membership Form

NEW Application for membership in the Independent Insurance Agents Of Hampden County, Inc.

To apply for membership, please complete the following form below. As an Agency, Vendor or Company Sponsor member, you will be listed on our web site for easy access by potential clients.

You will also be added to our E-Notice broadcast list for timely notices, events and meeting information.


Required *

Contact Person

Do you want IIAHC correspondence to be mailed to these branches?

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