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Purchase NSA Team Preferred Membership Benefits Rates Effective: 1/1/17 – 1/1/18

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  • Purchase NSA Team Preferred Membership Benefits Rates Effective: 1/1/17 – 1/1/18

Purchase NSA Team Preferred Membership Benefits
Rates Effective: 1/1/17 - 1/1/18

Instructions:
Please enter the information below to complete the application for the Team Preferred Membership Benefits Program. Once you have entered the required information click the button below 'Continue to Payment' and you will be brought to the payment gateway.

All highlighted fields are required to continue.

Please Allow 24 - 48 hours for processing

(4 teams or more)

Age Range
Number
X Rate
= Total Premium
8 and under
10 and under
12 and under
14 and under
16 and under
18 and under
20 and under
Adult
Total

(3 teams or less)

Age Range
Number
X Rate
= Total Premium
8 and under
10 and under
12 and under
14 and under
16 and under
18 and under
20 and under
Adult
Total
= Total Premium Due








Insured Teams:

If you don't have a NSA Sanction Number, go to:






To add more enter one team and NSA sanction number pair per line.

Additional Insureds:

(i.e.: field owners, municipalities, schools, parks, rec center, etc)


   


   

To add more enter below.

FaxedEmailed


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Premium is fully earned on the effective date of coverage. No pro-rata refunds will be made. Membership includes insurance premiums & association fees. I understand and agree that (a) if this application is accepted by the Company, coverage will begin on the date of acceptance or the date requested in the application, whichever is later, subject to payment of the required premium; and (b) Premium computation is subject to audit. Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Please check the box to verify and agree that the information provided herein is true and complete.

I Agree