Broker/Dealer Membership Form

 

If you are a new member, please fill out the membership form below and click submit. You will be contacted once your application has been approved. Once approved, you may pay your dues online via the Registration/Payments option in the Members Only section.  Broker/Dealer Fees are $300 per calendar year.

 

Effective membership is required for participation in our programs, including the E&O Share program.


Are you an industry vendor looking for the Industry Associate Membership application? Click here to download and submit the IAM registration form. Industry Associate Membership dues are $2500 and may be paid online via the Members Only section.


New Membership Form

 

 

Broker/Dealer Firm:
 CEO's Name:  
Your Name*
 Firm CRD#  
Main Contact Name:
Home Office Address:
Floor/Suite:
City
State:
Zip Code:
Main Telephone:*
Fax:
Mobile:
Your Email Address:*
Web:

 

Proposed Member Organization

Corporate Form:
State of Inc.
Date Broker/Dealer Founded:
Total Branches:
# of Registered Reps:
Registered in how many states?

Firm Focus

Retail Sales:
Product Sponsor:
Institutional Sales:
Underwriter:
Market-Maker:
Wholesaler:

 

Company Officers

Name: Title: Email:
Name: Title: Email:
Name: Title: Email:

 

All information contained herein and attached hereto will be reviewed by the National Association of Independent Broker/Dealers Membership Committee, and will be treated as confidential. Membership will be granted subject to the review and approval of the Board of Directors. Information available to the public may be reviewed in conjunction with this application.

The undersigned, being a duly licensed, FINRA Registered Broker/Dealer, does hereby apply for membership in the National Association of Independent Broker/Dealers, Inc. By submission of this application, including any attached data sheets, together with the appropriate fees, applicant hereby agrees to abide by the Corporate Bylaws of the Association and its Code of Ethics.

 

How did you learn of NAIBD membership?
By:
Title:

Membership Dues: $300.00


Proposing Member: Signature: Date:

 

To Submit Your Application, please click below:

Back to Membership

 

NAIBD
191 Clarksville Road, Princeton Junction, NJ 08550
www.naibd.com
     
NATIONAL ASSOCIATION OF INDEPENDENT BROKER DEALERS
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