MAPC APPLICANT:
ORGANIZATION:
ADDRESS:
CITY:
TELEPHONE:
TITLE:
MAPC SPONSOR:

I would be interested in serving on the following committee(s):


Why are you interested in becoming a MAPC member and what will your contribution be?


Please attach a copy of your curriculum vitae.
PLEASE RETURN TO: D. Jane Howard
Manager, Insurance Operations
Michigan Basic Property Insurance Association
PO Box 86
Detroit, MI 48231
FAX: 313.568.4749
MAPC Membership is limited to 60 active members.