Membership Form - Tennessee Self-Insurers Association

TNSIA Membership

Membership Fees for Self-Insured Employers, High Deductible Employers & Government Entities (Municipalities): $500 | Membership Fees for Associate Members: $750 | Important Notice: A portion of TNSIA’s annual budget is paid to the new TNSIA PAC. Political contributions are not tax deductible. TNSIA dues are not deductible as a charitable contribution for federal income tax purposes, but may be partially deductible as an ordinary and necessary business expense. TNSIA estimates that ten percent (10%) of your dues is not deductible because of TNSIA's lobbying activities on behalf of its members.

Company Name*
Company Address*
Company Address 2
Company Address - City*
Company Address - State*
Company Address - Zip*
Company Address - Country*
Primary Contact (First Name)*
Primary Contact (Last Name)*
Primary Contact Email Address*
Primary Contact Phone*
Additional Company Representatives
Please list: First & Last Name, Email, Phone
Membership Level*
Please Select One of the Following
Membership Fees Quantity*
Price: $500.00
Membership Fees Self-Insured Employers $500 | High Deductible Employers $500 | Government Entities (Municipalities) $500
Associate Member Fees Quantity*
Price: $750.00
Associate Membership Fees: Attorneys $750 | Other $750
Payment Type*
To pay by credit card, select Online/Paypal as your option. To pay by check select Offline and an invoice will be emailed to you. Please note, cancellation refunds will exclude PayPal Fees.