Nevada State Claims Association Membership Enrollment Form

MEMBERSHIP APPLICATION FORM
(Complete and pay online, or you can download an application form as a .doc for mailing with a check)
NOTE: Membership term is from July 1, 2010 until June 30, 2011.

Benefits include:

Nevada State Claims Association Official Website. Advertising discounts also available.
Quarterly Newsletter
Events and Educational Presentations
Listing in the printed Claims Directory
Networking with Industry Professionals

*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.