- 掃描 ID：
- 4d745f16-cb80-4a69-a0b6-2cac4301f326已完成
- 已提交的 URL：
- https://naifa.formstack.com/forms/revagency
- 報告完成時間：
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從頁面中識別的傳出連結
JavaScript 變數 · 找到 13 個
在頁面的視窗物件上載入的全域 JavaScript 變數是在函數外部宣告的變數，可從目前範圍內程式碼中的任何位置存取
| 名稱 | 類型 |
|---|---|
| onbeforetoggle | object |
| documentPictureInPicture | object |
| onscrollend | object |
| FormstackForms | object |
| v4msWebpackJsonp | object |
| clearImmediate | function |
| setImmediate | function |
| regeneratorRuntime | object |
| DD_RUM | object |
| FSForm | object |
主控台記錄訊息 · 找到 0 條
記錄到 Web 主控台的訊息
HTML
頁面的原始 HTML 主體
<!DOCTYPE html><html lang="en"><head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
<meta name="robots" content="noindex, nofollow">
<title>JoinUs-REV Agency $20/month - Formstack</title>
<link rel="icon" type="image/x-icon" href="//www.formstack.com/images/favicon/favicon.ico">
<style type="text/css">
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font-size: 16px;
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top: 6px;
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height: 20px;
top: 4px !important;
left: 3px;
overflow: visible;
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width: 15px;
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margin-right: 0;
border: 1px solid #1b9aff;
background-color: #ffffff;
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/* background-color: rgb(12 83 148 / 6%);*/
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background-color: #1b9aff;
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textarea#field124927715 {
height: auto !important;
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line-height: 1.4em;
margin: 0 !important;
margin-bottom: 0 !important;
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.fsCreditcardNumberField .fsCreditcardNumberField-icon {
position: absolute;
top: calc(50% - 14px) !important;
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.fsFeildFocus, .fsFeildFocused
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margin: 0px 10px !important;
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{
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margin-bottom: 3px;
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margin-top: 0px;
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@media (min-width:355px) and (max-width:565px)
{.fsborderradius .fsBody .fsForm {
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@media (min-width:567px) and (max-width:999px)
{.fsborderradius .fsBody .fsForm {
margin: 0px auto !important;
max-width: 500px;}
}
</style>
<style>*[data-reach-dialog-overlay] {
z-index: 4;
}</style><link rel="prefetch" as="script" href="https://static.formstack.com/forms/forms-renderer/builds/public/phoneValidation.js?chunkhash=c0eb132e5829966aa022&id=384"><link rel="stylesheet" href="//fonts.googleapis.com/css?family=Roboto:700,400"><style data-styled="active" data-styled-version="5.3.11"></style></head>
<body class="fsBody body-hosted-form">
<div id="fsform-container-5963742" class="fsform-container" data-formid="5963742"><a id="top-of-form-anchor-5963742" tabindex="-1" aria-hidden="true"></a><div data-testid="form-body" id="fsForm-5963742" class="StyledFormBody-sc-i2tr89-0 fsRnut fsBody fsForm-5963742"><div class="InnerFormBody-sc-o0t3bv-0 hjaXRz"><div id="fsHeaderImage" class="StyledHeaderImageContainer-sc-14jpw8m-0 fPMzOG"><div class="StyledHeaderImageSticky-sc-10kpdl9-0 jlSqpb"></div></div><form autocomplete="off" id="fsForm5963742" method="post" class="StyledForm-sc-1xaj75q-0 hbapPa fsForm" action="https://naifa.formstack.com/forms/index.php" novalidate="" enctype="multipart/form-data"><input type="hidden" tabindex="-1" name="displayTime" value="2024-12-02T16:04:38-05:00"><input type="hidden" tabindex="-1" name="formstackFormSchemaVersion" value="4"><input type="hidden" tabindex="-1" name="formstackFormRendererVersion" value="7.11.4"><input type="hidden" tabindex="-1" name="form" value="5963742"><input type="hidden" tabindex="-1" name="viewkey" value="A6wPUCGrQG"><input type="hidden" tabindex="-1" name="password" value=""><input type="hidden" tabindex="-1" name="_submit" value="1"><input type="hidden" tabindex="-1" name="incomplete" value=""><input type="hidden" tabindex="-1" name="incomplete_email" value=""><input type="hidden" tabindex="-1" name="incomplete_password" value=""><input type="hidden" tabindex="-1" name="latitude" value=""><input type="hidden" tabindex="-1" name="longitude" value=""><input id="fsUserAgent" type="hidden" tabindex="-1" name="fsUserAgent" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/119.0.0.0 Safari/537.36"><div id="fsPage5963742-1" class="StyledPage-sc-15mrpfq-0 hCMMok fsPage"><div data-testid="section0-col2" id="fsSection0" class="StyledSection-sc-1jyjf4h-0 kJUGOU fsSection"><span class="StyledLabel-sc-vn5hkq-0 izIbGe fsLabelVertical fsFieldCell" id="label-field174750973" for="field174750973" data-testid="field-174750973"><a id="field-anchor-174750973" tabindex="-1" aria-hidden="true"></a><div class=""><p style="text-align: center;"><br></p><p style="text-align: center;"><span style="font-size: 24px;">Membership Application</span></p><p style="text-align: center;">Need help? Call our Member Experience Team at <span dir="ltr">877-866-2432.</span></p></div></span><span class="StyledLabel-sc-vn5hkq-0 izIbGe fsLabelVertical fsFieldCell" id="label-field174750974" for="field174750974" data-testid="field-174750974"><a id="field-anchor-174750974" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel fsRequiredLabel"><span>Name</span><span class="StyledRequiredMarker-sc-d195mo-0 hfazLS fsRequiredMarker">*</span></div><div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup"><div class="StyledSubField-sc-1wt4t9i-0 vpZtd fsSubField fsNameFirst"><input autocomplete="given-name" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750974-first" type="text" label="Name" required="" maxlength="20" name="field174750974-first" data-fs-field-id="174750974" data-fs-field-name="name" data-fs-field-alias="first" value=""><label for="field174750974-first" class="StyledLabel-sc-vn5hkq-0 dGTISf">First Name</label></div><div class="StyledSubField-sc-1wt4t9i-0 gnMAlX fsSubField fsNameInitial"><input autocomplete="additional-name" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750974-initial" type="text" label="Name" maxlength="1" name="field174750974-initial" data-fs-field-id="174750974" data-fs-field-name="name" data-fs-field-alias="initial" value=""><label for="field174750974-initial" class="StyledLabel-sc-vn5hkq-0 dGTISf">Initial (optional)</label></div><div class="StyledSubField-sc-1wt4t9i-0 vpZtd fsSubField fsNameLast"><input autocomplete="family-name" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750974-last" type="text" label="Name" required="" maxlength="20" name="field174750974-last" data-fs-field-id="174750974" data-fs-field-name="name" data-fs-field-alias="last" value=""><label for="field174750974-last" class="StyledLabel-sc-vn5hkq-0 dGTISf">Last Name</label></div></div></span><label class="StyledLabel-sc-vn5hkq-0 haSlyN fsLabelVertical fsFieldCell" id="label-field174750975" for="field174750975" data-testid="field-174750975"><a id="field-anchor-174750975" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel fsRequiredLabel"><span>Email</span><span class="StyledRequiredMarker-sc-d195mo-0 hfazLS fsRequiredMarker">*</span></div><div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup"><div class="StyledSubField-sc-1wt4t9i-0 fFseqO"><input id="field174750975" type="email" maxlength="" label="Email" required="" autocomplete="email" class="StyledInput-sc-1cxwxcf-0 jeTypW fsFieldEmail" name="field174750975" size="50" placeholder="" data-fs-field-id="174750975" data-fs-field-name="email" data-fs-field-alias="value" value=""></div></div></label><label class="StyledLabel-sc-vn5hkq-0 haSlyN fsLabelVertical fsFieldCell" id="label-field174750976" for="field174750976" data-testid="field-174750976"><a id="field-anchor-174750976" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel"><span>Mobile Phone</span></div><input autocomplete="tel" class="StyledInput-sc-1cxwxcf-0 jeTypW fsFieldPhone" name="field174750976" id="field174750976" data-testid="field174750976" placeholder="" type="tel" data-fs-field-id="174750976" data-fs-field-name="phone" data-fs-field-alias="*" value=""></label><span class="StyledLabel-sc-vn5hkq-0 izIbGe fsLabelVertical fsFieldCell" id="label-field174750977" for="field174750977" data-testid="field-174750977"><a id="field-anchor-174750977" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel fsRequiredLabel"><span>Billing Address</span><span class="StyledRequiredMarker-sc-d195mo-0 hfazLS fsRequiredMarker">*</span></div><div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup"><div class="StyledSubField-sc-1wt4t9i-0 ZGYgs fsSubField fsFieldAddress"><input autocomplete="address-line1" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750977-address" type="text" label="Billing Address" required="" name="field174750977-address" aria-required="true" data-fs-field-id="174750977" data-fs-field-name="address" data-fs-field-alias="address" value=""><label class="StyledLabel-sc-vn5hkq-0 dGTISf fsSupportingSubLabel" for="field174750977-address">Address Line 1</label></div><div class="StyledSubField-sc-1wt4t9i-0 ZGYgs fsSubField fsFieldAddress2"><input autocomplete="address-line2" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750977-address2" type="text" label="Billing Address" required="" name="field174750977-address2" data-fs-field-id="174750977" data-fs-field-name="address" data-fs-field-alias="address2" value=""><label class="StyledLabel-sc-vn5hkq-0 dGTISf fsSupportingSubLabel" for="field174750977-address2">Address Line 2</label></div><div width="40%" class="StyledSubField-sc-1wt4t9i-0 cCCzhi fsSubField fsFieldCity"><input autocomplete="address-level2" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750977-city" type="text" label="Billing Address" required="" name="field174750977-city" aria-required="true" data-fs-field-id="174750977" data-fs-field-name="address" data-fs-field-alias="city" value=""><label class="StyledLabel-sc-vn5hkq-0 dGTISf fsSupportingSubLabel" for="field174750977-city">City</label></div><div width="40%" class="StyledSubField-sc-1wt4t9i-0 cCCzhi fsSubField fsFieldState"><select autocomplete="address-level1" class="StyledSelectInput-sc-1qjysc9-0 kVvAEQ" id="field174750977-state" type="address" label="Billing Address" required="" name="field174750977-state" aria-required="true" data-fs-field-id="174750977" data-fs-field-name="address" data-fs-field-alias="state"><option value=""></option><option value="AL">Alabama</option><option value="AK">Alaska</option><option value="AZ">Arizona</option><option value="AR">Arkansas</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DE">Delaware</option><option value="DC">District of Columbia</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="GU">Guam</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Missouri</option><option value="MT">Montana</option><option value="NE">Nebraska</option><option value="NV">Nevada</option><option value="NH">New Hampshire</option><option value="NJ">New Jersey</option><option value="NM">New Mexico</option><option value="NY">New York</option><option value="NC">North Carolina</option><option value="ND">North Dakota</option><option value="OH">Ohio</option><option value="OK">Oklahoma</option><option value="OR">Oregon</option><option value="PA">Pennsylvania</option><option value="PR">Puerto Rico</option><option value="RI">Rhode Island</option><option value="SC">South Carolina</option><option value="SD">South Dakota</option><option value="TN">Tennessee</option><option value="TX">Texas</option><option value="UT">Utah</option><option value="VT">Vermont</option><option value="VI">Virgin Islands (US)</option><option value="VA">Virginia</option><option value="WA">Washington</option><option value="WV">West Virginia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option><option value="AA">Armed Forces (the) Americas</option><option value="AE">Armed Forces Europe</option><option value="AP">Armed Forces Pacific</option><option value="APO">Army Post Office (U.S. Army and U.S. Air Force)</option><option value="FPO">Fleet Post Office (U.S. Navy and U.S. Marine Corps)</option></select><label class="StyledLabel-sc-vn5hkq-0 dGTISf fsSupportingSubLabel" for="field174750977-state">State</label></div><div width="20%" class="StyledSubField-sc-1wt4t9i-0 AddressFieldstyles__StyledZipCodeField-sc-5c6el4-0 dwDGro bOQyvw fsSubField fsFieldZip"><input autocomplete="postal-code" class="StyledInput-sc-1cxwxcf-0 jeTypW" id="field174750977-zip" type="text" label="Billing Address" required="" name="field174750977-zip" aria-required="true" data-fs-field-id="174750977" data-fs-field-name="address" data-fs-field-alias="zip" value=""><label class="StyledLabel-sc-vn5hkq-0 dGTISf fsSupportingSubLabel" for="field174750977-zip">ZIP Code</label></div></div></span><label class="StyledLabel-sc-vn5hkq-0 izIbGe fsLabelVertical fsFieldCell" id="label-field174750978" for="field174750978" data-testid="field-174750978"><a id="field-anchor-174750978" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel"><span>Comments or Referred By</span></div><textarea class="StyledInput-sc-1cxwxcf-0 iwzzFG fsFieldLongAnswer" id="field174750978" type="text" label="Comments or Referred By" name="field174750978" cols="50" rows="1" placeholder="" data-fs-field-id="174750978" data-fs-field-name="textarea" data-fs-field-alias="*"></textarea></label><span class="StyledLabel-sc-vn5hkq-0 haSlyN fsLabelVertical fsFieldCell" id="label-field174750979" for="field174750979" data-testid="field-174750979-vertical"><a id="field-anchor-174750979" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel fsRequiredLabel"><span>Bill me</span><span class="StyledRequiredMarker-sc-d195mo-0 hfazLS fsRequiredMarker">*</span></div><fieldset aria-labelledby="174750979-legend" role="radiogroup" aria-required="true" class="StyledFieldset-sc-1r8yz9c-0 StyledOptionWrapper-sc-1ah0fdf-0 cdlqHK PSYyM"><span style="position: absolute; left: -999em; width: 0.1em; height: 0.1em; overflow: hidden;"><legend id="174750979-legend">Bill me</legend></span><div><label for="field174750979_1" class="StyledOptionLabel-sc-1bymt4x-0 jJDdMA fsOptionLabel"><input label="Bill me" required="" class="StyledOptionButton-sc-wqe0tc-0 fMxkVs" type="radio" name="field174750979" id="field174750979_1" data-fs-field-id="174750979" data-fs-field-name="radio" data-fs-field-alias="*" value="Monthly"><span>Monthly</span></label></div><div><label for="field174750979_2" class="StyledOptionLabel-sc-1bymt4x-0 jJDdMA fsOptionLabel"><input label="Bill me" required="" class="StyledOptionButton-sc-wqe0tc-0 fMxkVs" type="radio" name="field174750979" id="field174750979_2" data-fs-field-id="174750979" data-fs-field-name="radio" data-fs-field-alias="*" value="Annually"><span>Annually</span></label></div></fieldset></span><span class="StyledLabel-sc-vn5hkq-0 haSlyN fsLabelVertical fsFieldCell" id="label-field174750980" for="field174750980" data-testid="field-174750980"><a id="field-anchor-174750980" tabindex="-1" aria-hidden="true"></a><div class=""><p><span style="font-size: 18px;">We use the honor system because NAIFA ascribes to a Code of Ethics. By selecting your correct rate below based on the number of years you have been licensed, you confirm that you are committing to our Code of Ethics.</span></p><p><span style="font-size: 18px;">Have any questions or a special circumstance? Please call Michele Borsuk at 610-526-2555</span></p></div></span><span class="StyledLabel-sc-vn5hkq-0 haSlyN fsLabelVertical fsFieldCell" id="label-field174750981" for="field174750981" data-testid="field-174750981"><a id="field-anchor-174750981" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel fsRequiredLabel"><span>Credit Card</span><span class="StyledRequiredMarker-sc-d195mo-0 hfazLS fsRequiredMarker">*</span></div><span style="position: absolute; left: -999em; width: 0.1em; height: 0.1em; overflow: hidden;"><legend id="field174750981">Credit Card</legend></span><div class="StyledSubFieldGroup-sc-ik27pq-0 gfzGQs fsSubFieldGroup"><div class="StyledSubField-sc-1wt4t9i-0 iwvZSz"><img src="data:image/svg+xml;base64,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" class="StyledCreditCardIcon-sc-1xby9rt-0 krZZjp" alt=""><input placeholder="xxxx xxxx xxxx xxxx" class="StyledInput-sc-1cxwxcf-0 StyledCreditCardInput-sc-zwukiu-0 StyledCreditCardInput__StyledCreditCardNumberInput-sc-zwukiu-1 jeTypW fvnHJc dMSQTF" name="field174750981-card" id="field174750981-card" required="" aria-required="true" aria-labelledby="field174750981-card-label" aria-label="Card number" data-fs-field-id="174750981" data-fs-field-name="creditcard" data-fs-field-alias="card" autocomplete="new-password" autocorrect="off" value=""><label id="field174750981-card-label" class="StyledLabel-sc-vn5hkq-0 dGTISf">Card number</label></div><div width="20%" class="StyledSubField-sc-1wt4t9i-0 gPORrs fsSubField"><input placeholder="MM / YY" class="StyledInput-sc-1cxwxcf-0 StyledCreditCardInput-sc-zwukiu-0 jeTypW fvnHJc" data-testid="cc-card-174750981" name="field174750981-cardexp" id="field174750981-cardexp" required="" aria-required="true" aria-labelledby="field174750981-cardexp-label" aria-label="Expiration date" data-fs-field-id="174750981" data-fs-field-name="creditcard" data-fs-field-alias="cardexp" autocomplete="new-password" autocorrect="off" value=""><label id="field174750981-cardexp-label" class="StyledLabel-sc-vn5hkq-0 dGTISf">Expiration date</label></div><div width="20%" class="StyledSubField-sc-1wt4t9i-0 gPORrs fsSubField"><input placeholder="" class="StyledInput-sc-1cxwxcf-0 StyledCreditCardInput-sc-zwukiu-0 jeTypW fvnHJc" name="field174750981-cvv" id="field174750981-cvv" required="" aria-required="true" aria-labelledby="field174750981-cvv-label" aria-label="CVC" data-fs-field-id="174750981" data-fs-field-name="creditcard" data-fs-field-alias="cvv" autocomplete="new-password" autocorrect="off" value=""><label id="field174750981-cvv-label" class="StyledLabel-sc-vn5hkq-0 dGTISf">CVC</label></div></div></span><span class="StyledLabel-sc-vn5hkq-0 haSlyN fsLabelVertical fsFieldCell" id="label-field174750982" for="field174750982" data-testid="field-174750982-vertical"><a id="field-anchor-174750982" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel fsRequiredLabel"><span>Membership Fees</span><span class="StyledRequiredMarker-sc-d195mo-0 hfazLS fsRequiredMarker">*</span></div><fieldset aria-labelledby="174750982-legend" role="radiogroup" aria-required="true" class="StyledFieldset-sc-1r8yz9c-0 StyledOptionWrapper-sc-1ah0fdf-0 cdlqHK PSYyM"><span style="position: absolute; 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Offer valid only for new NAIFA members. </span></span></span><label class="StyledLabel-sc-vn5hkq-0 izIbGe fsLabelVertical fsReadOnly fsFieldCell" id="label-field174750983" for="field174750983" readonly="" data-testid="field-174750983"><a id="field-anchor-174750983" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel"><span>Terms and Conditions</span></div><textarea class="StyledInput-sc-1cxwxcf-0 cgUGIY fsFieldLongAnswer" readonly="" id="field174750983" type="text" label="Terms and Conditions" name="field174750983" cols="50" rows="13" placeholder="" data-fs-field-id="174750983" data-fs-field-name="textarea" data-fs-field-alias="*">PAYMENT TRANSACTION AUTHORIZATION: By entering my payment information above and agreeing to the terms of this authorization as of today’s date, I authorize my payment(s) in the amount stated to be processed as electronic funds transfer(s) (EFT) drawn by NAIFA or NAIFA’s service provider from the account I provided or as credit card transaction(s) using the credit card I provided. I understand that my payment(s) will be processed within approximately 1-2 banking days. If any of my payments return unpaid, I authorize NAIFA or NAIFA’s service provider to collect the returned payment(s) by EFT drawn from my account. By enrolling in the monthly membership option, I authorize my payment(s) in the amount stated to be drawn by NAIFA or NAIFA’s service provider automatically each month on my expiration date. I understand and agree that this authorization will remain in full force and effect until I notify NAIFA that I wish to revoke this authorization by calling NAIFA at 877-866-2432 and I will allow NAIFA a reasonable period of time (e.g., approximately 10 banking days) to act on my notice. (Please retain a copy of this authorization for your records or request a free copy from NAIFA at the phone number above.) NAIFA reserves the right to adjust monthly or annual dues amounts at any time for any reason without prior notice.
Non-Deductibility of Lobbying Expenses Disclosure Statement: While association dues payments may be deductible by members as an ordinary and necessary business expense (except for that portion of dues attributable to lobbying), dues are not deductible as charitable contributions for federal income tax purposes. By paying your membership fees, you agree to adhere to the NAIFA Code of Ethics and NAIFA Policies.
</textarea></label><label class="StyledLabel-sc-vn5hkq-0 izIbGe fsLabelVertical fsReadOnly fsFieldCell" id="label-field174750984" for="field174750984" readonly="" data-testid="field-174750984"><a id="field-anchor-174750984" tabindex="-1" aria-hidden="true"></a><div class="StyledLabelText-sc-1bsmirz-0 dixuEj fsLabel"><span>2024 Non-Deductibility of Lobbying Disclosure Statement</span></div><textarea class="StyledInput-sc-1cxwxcf-0 cgUGIY fsFieldLongAnswer" readonly="" id="field174750984" type="text" label="2024 Non-Deductibility of Lobbying Disclosure Statement" name="field174750984" cols="50" rows="10" placeholder="" data-fs-field-id="174750984" data-fs-field-name="textarea" data-fs-field-alias="*">2024 Non-Deductibility of Lobbying Expenses Disclosure Statement: While association dues payments may be deductible by members as an ordinary and necessary business expense, dues are not deductible as charitable contributions for federal income tax purposes. To determine the total non-deductible portion of your dues for the period of January 1, 2024-December 31, 2024, add the NAIFA National lobbying expense ($110) to your state association’s lobbying expense (see table below):
Alabama ($0)
Alaska ($0)
Arizona ($18)
Arkansas ($32)
California ($58)
Colorado ($121)
Connecticut ($117)
Delaware ($25)
Dist. Of Columbia ($17)
Florida ($75)
Georgia ($42)
Guam ($50)
Hawaii ($42)
Idaho ($20)
Illinois ($34)
Indiana ($45)
Iowa ($41)
Kansas ($40)
Kentucky ($0)
Louisiana ($72)
Maine ($141)
Maryland ($50)
Massachusetts ($87)
Michigan ($57)
Minnesota ($65)
Mississippi ($24)
Missouri ($14)
Montana ($55)
Nebraska ($67)
Nevada ($53)
New Hampshire ($180)
New Jersey ($25)
New Mexico ($0)
New York ($50)
North Carolina ($37)
North Dakota ($5)
Ohio ($46)
Oklahoma ($52)
Oregon ($173)
Pennsylvania ($7)
Puerto Rico ($0)
Rhode Island ($0)
South Carolina ($49)
South Dakota ($42)
Tennessee ($18)
Texas ($9)
Utah ($6)
Vermont ($0)
Virginia ($13)
Washington ($123)
West Virginia ($0)
Wisconsin ($87)
Wyoming ($0)
Publication Subscription Notice: NAIFA is required to inform you of the cost of your state and/or national magazine subscription, which is included in your membership dues. This amount is not deductible from your dues. The amount of your Advisor Today subscription is $6. The following states have reported subscription costs for their publications: Iowa: $.50; Tennessee: $1; and Virginia: $1.
Membership Terms & Conditions: By enrolling in the monthly auto renewal program, you authorize NAIFA to charge/debit the account specified on the front of this form. The authorization shall remain in full force and effect until NAIFA has received written notification from you of its termination. Written notification must be received by NAIFA 2 business days prior to the monthly draft to avoid a draft/charge for the following month. If your membership has lapsed within the last 90 days, the first debit/charge will reflect the amount due for the delinquent months. The monthly amount includes a $1/month transaction fee. Membership dues paid to NAIFA are not refundable, except as may be prescribed by the NAIFA Board of Trustees. NAIFA reserves the right to adjust monthly or annual dues amounts at any time for any reason without prior notice. (Each year, beginning on January 1st, 2023, membership fees will be automatically adjusted by 3%).
Membership Agreement: As a member, you agree to abide by the association bylaws and NAIFA’s Code of Ethics (see https://belong.naifa.org/code-of-ethics), and you authorize NAIFA to contact you by mail, phone, fax, email or text message using the contact information provided by you on the front of this form. You understand that NAIFA may share your contact information with member benefit affinity providers.
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