We are a not-for-profit community and would like to support the Insurance Reform Campaign to save consumer rights and keep insurers honest.

*Organisation:

supports the mission of the Insurance Reform Campaign which calls for immediate reforms to the insurance industry and authorises the Insurance Reform Campaign to mention this support in connection with its activities. The Insurance Reform Campaign agrees to keep the above mentioned organisation informed of its activities.

*Contact Name

*Position

*Email Address:

*Address:

*Suburb/City:

*Post Code:

Phone:
Area Code
Fax:
Area Code

Please check boxes if applicable:
  We want to learn more about the IRC and how we can become more involved. Let us know how we can support grassroots IRC activities in our area.
  We would like to be kept informed about legislation and would consider signing onto letters to law makers in support of or opposition to specific legislation. We understand that our name will not be used on any lobbying materials without prior review and consent.
Optional: If yours is a membership organisation, how many members do you have?