Nevada State Claims Association Membership Enrollment Form

MEMBERSHIP APPLICATION FORM
(Complete and pay online, or you can complete and print this page or download an application form as a .doc for mailing with a check)
NOTE: Membership term is from July 1, 2011 until June 30, 2012.

Benefits include:

Nevada State Claims Association Official Website. Advertising discounts also available.
Quarterly Newsletter
Events and Educational Presentations
Listing in the printed and online Claims Directory
Networking with Industry Professionals
Discounts at monthly Luncheons and other Educational events
Membership in both Northern and Southern chapters

*Name:*
*email:*
*Company:*
*Address:*
*City, State ZIP:*
*Phone:*
*Fax:*
*Website:*
*I would like to enroll in the:*	Northern Nevada Claims Association Southern Nevada Claims Association
Membership Type:	Member (Adjuster) Associate Member (all others)
Annual Dues	Individual: $40 Company: $175 (four or more members)
	Check here if you would like your business/organization to be included in the Claims Directory.
*Message:*
*Confirmation:*	Please enter the word you see above.