PIA collects information about its members to help expand our grassroots advocacy efforts. The information in this survey will be used to conduct issue-specific outreach to affected members. We hope to use your experiences and expertise as a roadmap for our advocacy activities.

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* 1. Name

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* 2. Email

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* 3. State

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* 4. Please choose the line(s) of insurance that affect your agency:

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* 5. PIA’s work often includes issues that are not specific to insurance. Please choose the most important issue(s) you and/or your agency face:

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* 6. Is your agency organized as an S corporation

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