IBAH | New Member Application

Complete the form here to submit your application to become a new member or associate member of the Insurance Brokers Association (IBAH) of Hamilton.

Submit Your Application Online

To submit your application online and pay using a credit card through our secure payment portal, please complete the form on this page.

Once you click 'submit', you will be redirected to our online payment portal, where you will have the option to pay by VISA, MASTERCARD, or AMERICAN EXPRESS.

Prefer to Use Paper?

No problem! Mail your completed application, along with your cheque to:

Brittany Mildenberger, Binbrook Insurance Brokers, 2567 Binbrook Rd, Binbrook, ON L0R 1C0

Questions? Contact Brittany at 905-692-4418

DOWNLOAD IBAH NEW MEMBER APPLICATION »

Apply for IBAH Membership

Company Name: *

Street Address: *

City: *

Postal Code: *

Company Website: *

Company Phone: *

Company Fax: *

Contact Name: *

Contact Email Address: *

# Total Staff: *

# RIBO Licenced: *

# Unlicenced: *

What type of membership? *

Member

Associate Member

How are you paying? *

Online

Cheque (Mail in)

Upload company logo (high resolution): *

Browse...

Other details or comments:

Spam Blocker