OTHER COMPANY SUBSCRIBER MEMBERSHIP
Please complete the
following questions for membership in the Cincinnati Insurance
Board.
__ New____ Renewal Please complete the following questions for membership in the Cincinnati Insurance Board.
Name: ____________________________________________________________________Company: _________________________________________________________________
Street Address: _____________________________________________________
P.O. Box: ________________________________________________________________
City: ___________________________________________ STATE: ________ Zipcode: ____________
Phone: _________________________________ FAX: __________________________________
Internet address: ____________________________________________________________E-Mail Address: ____________________________________________________________
Company product or service: __________________________________________________
Annual Company membership dues: $250.00
Make your check payable to the Cincinnati Insurance Board and
Send it to: The Cincinnati Insurance Board
5535 Fair Lane, Suite A
Cincinnati, Ohio 45227