First Name *

Last Name *

Organization *

Title *

Email *

Phone *

Website Address *

Address Line 1 *

Address Line 2

City *

State *

Enter required value

Postal Code *

Select Membership Type *

Full Insurer: Annual amount is based on direct premiums written in New York. Call NYIA at 518.432.4227 for a quote. Full Insurer Members are members duly admitted to membership which are property and casualty insurance companies, societies or organizations licensed to engage in one or more lines of insurance business in the State of New York.

Insurer Organization: Annual amount is based on direct premiums written in New York. Call NYIA at 518.432.4227 for a quote. Insurer Organization Members are members duly admitted to membership which are organizations created by New York statute whose membership includes two or more Insurer Members required to be members of such organization.

Reinsurer: $5500 Annually – Reinsurer members are members duly admitted to membership which (i) are insurers accredited in New York State in compliance with the Insurance Law of New York, to engage in the business of reinsurance, or; (ii) an organization or person licensed as a Reinsurance Intermediary under Section 2106 of the Insurance Law of New York as a Reinsurance Intermediary.

Subscriber: $1800 Annually – Subscriber members are members duly admitted to membership including any person or organization having any interest in the welfare of the insurance industry that does not have any direct written premium (vendor, law firm, association, etc.).

Affiliate: $1800 Annually – Affiliate members are members duly admitted to membership including any association, organization, corporation or law firm that does not have any direct written premium and engages in lobbying.

NY Direct Premiums Written (2 Years Prior)

For full insurer and insurer organization memberships only. (Annual Statement Schedule T - line 33, column 2) 

Company Type *

Select from the options below. If other, please provide company type.

Enter required value Stock Mutual Cooperative Other

New York Domestic *

Select yes or no. If no, please provide state company is domiciled in.

Enter required value Yes No Other

Lines of Insurance Written

Auto Commercial

Auto Personal

Farm

Fire

Landlord

Marine

Professional Liability

Property Commercial

Property Personal

Workers Compensation

Medical Malpractice

Company Description *

Correspondence Authorization *

I understand that by providing the contact information above, I consent to receive correspondence sent by or on behalf of the New York Insurance Association, Inc., New York Insurance Association, Inc. PAC and New York Insurance Scholarship Foundation. Contact information will not be shared outside of the association and these related entities. Membership is renewed automatically in January, unless resignation is received on or before November 1st of the year prior to effective resignation year.

Acceptance of Bylaws *

Click here to review and accept the association bylaws. Once you have signed the form, please upload the signed last page of the document by using the file share below.

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