Become A Member Of The North American Contingency Association







	Our Sponsors:

Membership in NACA is open to the underwriting, brokerage, MGA's, advisors, risk managers, reinsurance, loss control, legal and claims communities that are involved with transacting and or servicing contingency business. Promotional and Marketing companies are also welcome to join. Although NACA denotes North America our English Brethren are invited and encouraged to become members as well as those representing facilities in Bermuda or elsewhere.

Applicant Information:

Date

Membership Status*

New Current

First Name*

Last Name*

Title

Company*

Address*

Address 2

City*

State/Province*

Zip/Postal Code*

Country

Phone*

Fax

E-mail address*

Web Address

Company Description:

How did you hear about NACA?

Are you a licensed Agent or Broker in the U. S.? Yes No

If yes, in what states?

Alabama	Louisiana	Ohio
Alaska	Maine	Oklahoma
Arizona	Maryland	Oregon
Arkansas	Massachusetts	Pennsylvania
California	Michigan	Rhode Island
Colorado	Minnesota	South Carolina
Connecticut	Mississippi	South Dakota
Delaware	Missouri	Tennessee
Florida	Montana	Texas
Georgia	Nebraska	Utah
Hawaii	Nevada	Vermont
Idaho	New Hampshire	Virginia
Illinois	New Jersey	Washington
Indiana	New Mexico	West Virginia
Iowa	New York	Wisconsin
Kansas	North Carolina	Wyoming
Kentucky	North Dakota

Corporate Membership: Annual corporate membership dues are $400.

A corporate membership provides membership for up to ten employees in your corporation. The Corporate membership will consist of one appointed (voting) member, and up to nine associate (non voting) members.

Appointed Corporate Membership: Your Company may appoint one individual to act as the official spokesperson. Benefits as an appointed member are subject to payment of dues and include a vote on member issues, your name and company information posted on the NACA web site, access to password protected areas of the NACA web site, the right to attend Board Meetings, and discounts on all Association Events.

Associate Corporate Members: Your Company may list up to 9 additional members as Associate Members. Benefits as an associate member are subject to payment of dues and include your name and company information posted on the NACA website, access to password protected areas of the NACA website, the right to attend Board Meetings and discounts on all Association Events. This will not include the right to vote on member issues.

Appointed Corporate Member

Associate Members:

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Name
Phone
Fax
E-mail address

Accounts Payable contact for corporate dues:

Name*
Phone*
Fax
E-mail address*
	* Required Fields