IBBA Broker Roundtable Application

Name*

Company Name*

City*

State/Province*

Zip/Postal Code*

Country*

Time Zone*

This information will be used when scheduling IBBA Broker Roundtable calls.

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International Time Zone

If you are outside of the Continental US and Canada and selected Other above, please enter your time zone below.

Phone Number*

Email Address*

Years as Broker*

Primary Market*

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If you selected Other as your Primary Market above, please list your primary market below.

Additional Detail (OPTIONAL)

If you would like to select one of the more specific markets in the drop-down below, this may assist the Membership Committee in selecting participants for the pilot program.

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Preferred Call Time*

Please select your first choice for a monthly IBBA Broker Roundtable call below. These are not necessarily the ONLY two options for the pilot program's monthly calls, but rather a starting point to establish potential availability of participants.

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