NewUFAA Membership Application (Page 1)

PRINTABLE APPLICATION YOU CAN FAX OR MAIL IN

- Below

Mission Statement - The United Farmers Agents Association is a professional Association committed to helping our members through education, communications, support and information, and to establish a true partnership with Farmers Group, Inc.

I am currently a Farmers Insurance agent, active or retired in good standing with the company and do hereby apply for membership in the United Farmers Agents Association, Inc., I agree to abide by the Bylaws and the Code of Ethics. I further agree with the General Objectives of UFAA and the Specific Security Objectives of UFAA.

Please provide the following information about yourself: (All fields are required)

Name
Agent Number	--
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
FAX
E-mail
I am a:	Active Farmers Agent Retired Farmers Agent

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