Raleigh Claims Association North Carolina Adjusters Association 2009 Application for Adjuster Membership   Membership may be granted to persons professing connection on behalf of insurance companies, independent adjusting companies and any other person holding a North Carolina Property and Casualty License with investigation, adjustment, or examination of insurance claims and losses, except such persons as hold themselves out as attorneys practicing independently. Date: ___________________________________ Please print legibly! If you cannot print legibly, please type or attach a business card. All members must complete Membership Application annually. Name: ________________________________________________________________ License(s) Held: ________________________________________________________ Professional Designations (CPCU, AIC, etc.) _________________________________ Length of Time Adjusting: ________________________________________________ All meeting notices sent throughout the year are sent only via email. Please indicate whether you prefer: __ Home Email Address _______________________ ---__ Work Email Address_______________________ Home Address: _____________________________________________________________ Home Telephone: ____________________________________________________________ Cell Phone: _________________________________________________________________ Job Title: ___________________________________________________________________ Employer/Company Name: _____________________________________________________ Company Mailing Address: _____________________________________________________ Work Telephone: ____________________________________________________________ Are you interested in helping Board members with events (ie, Golf Outing, Christmas Party?) 0yes 0no Are you interested in serving on the Board of Directors? (2+ years of RCA membership required) 0yes 0no Your $10.00 Annual Membership Dues includes calendar-year membership in both the Raleigh Claims Association and the North Carolina Adjusters Association. Please send your $10.00 membership dues to: Raleigh Claims Association P.O. Box 10183 Raleigh, NC 27605-0183 _________________________________ For Board Use Only: Date Received________________ Amount______________________ Receipt Sent:_________________ Email Verified on Membership List________________