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APPLICATION FOR REGULAR MEMBERSHIP

TEXAS ASSOCIATION OF PUBLIC INSURANCE ADJUSTERS
TAPIA is a non-profit organization dedicated to establishing and maintaining high standards of professional conduct on the part of public insurance adjusters in the State of Texas and protecting the insured public. Only persons who are licensed Public Insurance Adjusters in Texas may apply for regular membership. Membership is limited to individuals who fulfill the requirements of TAPIA as set by the board and membership, and who abide by the TAPIA Code of Professional Conduct and Ethics. Please fill in the information below:

Please follow our 2 step process to Join/Renew Your Membership

Step 1: fill out information in form below, after clicking submit you will be taken to step 2 to make your membership payment.

Step 2: Pay $500 annual fee to complete your membership

Name:
Firm Name:
Email Address:
Website Address:
Phone:
Cell Phone:
Years in Public Adjuster Profession
Number of Public Adjusters in Firm
When and where other licenses as a Public Adjuster obtained:
Texas Public Adjuster License Number:
Are you engaged in any business other than public adjusting?	yes no
Are you engaged in any way in building construction or damage restoration?	yes no
List business or professional organizations to which you belong:
Have you ever been reprimanded or disciplined by any Insurance Department or State?	yes no
If yes, furnish particulars:
Has your Public Adjuster License ever been suspended or revoked?	yes no
If yes, furnish particulars:
Have you had any complaints filed against you with or by any state's licensing authority?	yes no
If yes, please provide particulars:
Home Address:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Phone:
Additional qualifications:
I attest that all information on this application is true and accurate to the best of my knowledge. I will comply with the Bylaws and membership rules of TAPIA if my membership is approved. If my license is suspended or revoked I agree to advise TAPIA as soon as possible and abide by TAPIA rules regarding suspension or revocation of my membership in this organization. Agree
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