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Membership Application or Renewal

Application for Membership or Renewal

Membership or Renewal Application
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Membership Fees

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, or contact us and we will mail you an application.

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