Membership Application

Renewals

If you are a past member and would like to renew, please click here click here.

New Member Application

Membership is available to any current or retired independent contract State Farm agents. If you would like to join NASFA and you have not been a member in the past, please join via our secure service below.

If you prefer to download an application to mail or fax, click here.

Please enter your information below. Please fill in the form as completely as possible.

Membership Type:

NASFA membership is available in multiple levels that indicate the member's commitment to the organization and its mission. Dues can be paid annually, semi-annually or monthly by Debit or credit card.

* 12-month minimum commitment. By selecting the recurring payment option, you authorize us to continue your membership automatically, charged to the credit card provided for the plan you have selected above, until otherwise notified.

Membership Level	Annual	Semiannual*	Monthly*
Regular Member	$300	$160	$30 /mo
Gold Member	$348	$184	$34 /mo
Platinum Member	$540	$280	$50 /mo
Retired Member	$126	$68	$13 /mo
Retired Gold	$150	$80	$15 /mo

Not ready to join NASFA? Try our Digital Subscription.

First Name:

Last Name:

Credentials:

Title / Position:

Company Name:

Address 1:

Address 2:

City:

State:

Zip:

Home Phone:

(###) ###-#### Format

Work Phone:

(###) ###-#### Format

Mobile Phone:

(###) ###-#### Format

Fax:

(###) ###-#### Format

Email Address (Personal):

"Personal Email" is a non-State Farm email address. Emails pertaining to your membership will be sent to this address.

Email Address (Work):

"Work Email" will only be used to send generic information and is optional.

Website:

Please enter as "http://"

Contract Type:

How did you learn about NASFA:

Renewing Member
From a fellow agent
Needed legal services

Do you know of any fellow agents who might benefit from NASFA membership? Please be sure to provide their name and a personal (preferably not State Farm) email address so that we may contact them.

Password:

Passwords must be between 7-15 alphanumeric characters and contain at least one number.

Confirm Password:

Anonymous Membership:

If you prefer, your membership with NASFA can be anonymous. NASFA never releases its membership list to other organizations, but anonymous membership guarantees that not even NASFA's executive board will know you are a member. This right to privacy is assured by NASFA and has been protected by the courts, so you can enjoy the benefits of NASFA membership in complete privacy. Just check this box.

Check here to make your membership anonymous.

Discount Code

If you have been provided with a Discount Code, please enter it here.

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