Please use the space below to provide the requested information about the company applying for membership.
Please use the space below to select category into which the above company best fits.
Please list the names of any parent company, affiliates, subsidiaries or other company related to the applicant company that is involved in the structured settlement business and indicate their involvement in structured settlements.
I understand that the NSSTA Membership Committee and the NSSTA Membership Board of Directors must favorably consider this application prior to acceptance. By signature hereto, I declare that the facts herein are true and complete to the best of my knowledge. I also state that my organization, voting and professional members are actively involved in, associated with, or have an interest in the furtherance of periodic payment of compensation on account of personal physical injuries as set forth in Article II of the NSSTA Bylaws.