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Membership Application or Renewal

Application for Membership or Renewal

Membership or Renewal Application

Dues Schedule

Member Classification Average Number of Employees Active Active(Not For Profit) Public
Entity Affiliate
Class I Over 10,000 $1050 $875
Class II 5,000–9,999 $875 $437.50
Class III 3,000–4,999 $700 $350
Class IV 1,000–2,999 $525 $262.50
Class V 1–999 $350 $175
Professional Not Applicable $350 $350
City
State/Province
Zip/Postal
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Membership fees for Companies with Over 10,000 Employees

Membership dues for Companies with 5,000 - 9,999 Employees

Membership dues for Companies with 3,000 - 4,999 Employees

Membership dues for Companies with 1,000 - 2,999 Employees

Membership dues for Companies with 1 - 999 Employees

Membership fees for Professionals

$

Questions or Concerns?

If you have any questions regarding membership, please contact Heidi Mahoney, NYSIA Secretary, phone: 716-668– 0822; fax: 716-668–5035; e-mail: secretary@nyselfinsurance.com. Make checks payable to: New York Self-Insurers Association, and mail application to the address at the top of this page or charge to your credit card.

Click here for a PDF Version of NYSIA Application for Membership, Including Dues Schedule, or contact us and we will mail you an application.

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