Join PIA PIANC Members - Independent Together New Member Form We welcome you as a new PIANC Member! If you have any questions please contact Lisa Farnham at 804-486-4222 or email her at LisaF@pianc.net. Membership Type* Agency Main Memberhsip Additional Voting Membership Agency Branch Memberhsip Retiree Memberhsip First Name* Last Name* Preferred Name Email* Company Name - If no company enter your name.* NPN* - This field is required if you are taking CE classes with us. E&O Expiration Date Current E&O Carrier Phone*Address on your NCDOI License* City* State* Zip Code* Individuals who will assist me in processing and maintaining my agency's membership. Please include name, email, and phone of assistaing individuals.Consent* I certify that the information on this application is true and correct and I allow PIA to communicate with the agency or individual listed here via US mail, fax or email.