Texas Alliance of Nonsubscribers
Online Application

For more information you may contact: 512-480-0637
 
Type of membership sought: Nonsubscribing member
Associate
Company Name: *
Mailing Address: *
City: *
State: *
Zip Code: *
Name of Contact: *
Title of Contact:
Email of Contact: *
Phone: * (i.e. ###-###-####)
Fax:
 
For Nonsubscribing Member Applicants:
# of Texas employees on January, 30 :
# of Texas employees on August, 30 :
 

Your company will be billed for its dues based on the following guidelines:
Membership to the organization is open to nonsubscribing businesses in Texas who maintain an occupational injury benefits plan. Regular member dues for 2010 will be $1.00 per Texas employee based on the company’s average headcount using January 30th and August 30th of the previous year to determine the average. Minimum dues for employers with greater than 250 Texas employees are $1,500. Dues for small employers with fewer than 250 employees are $500. Dues are capped at $15,000 regardless of the number of employees. The term of membership is 12 months.


A one-year, non-voting trial membership (Associate Member Friend) is available at .50 cents per employee with a $500 minimum and $5000 maximum. For more information on the Associate Membership Friend category contact Tim Conger ()
 
For Associate Member Applicants:
Type of Company: Third Party Administrator
Business Associate
Insurance Carrier
Other
 
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Printable Applications

Click here to download a printable version of the Membership Application (in PDF format).

Click here to download a printable version of the Associate Membership Application (in PDF format).

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