Registration

This form is for those who are not yet registered individually with NIBA.

If you have already registered, please login here to update your contact details or to subscribe to the Insurance Adviser magazine.

Registering gives you access to member discounts on educational and social events (if applicable), and allows you to subscribe to our email alerts and weekly e-newsletter Broker Buzz.

Privacy: NIBA collects and maintains information, as part of its processes, we do so in accordance with Australian Privacy Principles. Please read the NIBA Privacy Notice that explains our approach to privacy. Full details of our Privacy Policy are available on our website.

Your Details
User Name *
Password *
Confirm Password *
Email Address *
Email Subscriptions:	Membership   Events   Education   News   Conventions
Broker Buzz:	Please select... Yes No
Title:	Select title... Mr Mrs Miss Ms Dr
First Name: *	* Preferred:
Middle Name:
Surname: *	* Previous:
Date of birth:  *	(dd/mm/yyyy)
Direct Line: *
Home Phone:
Mobile:
Fax:
This will be used to contact you if you leave your current company
Personal Email: *
Correspondence To:	Company Address Personal Address Personal Postal Address
Personal Address
This will be used to contact you if you leave your current company.
Address:
City:
State:	Select state ... ACT NSW QLD VIC NT SA WA TAS n/a
Postcode:
Country:
Postal Address (if different from above)
Address:
City:
State:	Select state ... ACT NSW QLD VIC NT SA WA TAS n/a
Postcode:
Country:
Company Details
Company Name:
Position:
Address:
City:
State:	Select state ... ACT NSW QLD VIC NT SA WA TAS n/a
Postcode:
Country:
Company Phone:
Supervisor
Name:
Email:
Phone: