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Company Name

Company Address

Main Contact Details

Membership Type

Select below whether you are applying for a domestic insurance company membership or an affiliate membership.

Domestic Insurance Company Member - Charged by DWP

If you are applying as a domestic insurance company, please select your company's DWP as reported to the Ohio Department of Insurance as of December 31st of the prior year from the list below. Please only check one box.

AMOUNT
305.00
TOTAL
AMOUNT
383.00
TOTAL
AMOUNT
457.00
TOTAL
AMOUNT
536.00
TOTAL
AMOUNT
609.00
TOTAL
AMOUNT
908.00
TOTAL
AMOUNT
1,066.00
TOTAL
AMOUNT
1,213.00
TOTAL
AMOUNT
2,284.00
TOTAL

Affiliate Member

AMOUNT
575.00
TOTAL
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Thank you for applying to become an OAMIC member! Once your application is approved, we will email you with details to submit payment. If you have any questions in the meantime, email us at info@oamic.org.

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