Insurance CE

Insurance Pre-Licensing

Contact Information:

Phone: 512.343.9058

Thank you for visiting TSLA, a non-profit, trade association of excess and surplus lines brokerage and underwriting professionals. If you would like more information about our association and membership benefits, please contact us at your convenience:

phone:
512.343.9058

address:
Great Hills Corporate Center
9020-I Capital of TX Hwy N., Suite 370
Austin, TX 78759

email:
jptsla@tsla.org

information:
Info Request Form

TSLA Dues Renewal Statement

2023 Membership Renewal

If you wish to pay the membership dues for your firm by check or credit card, please complete the information below:

This Online Application is on a Secure
Server. Click on the seal on the left
for more information on the
certificate's authentication.

Please note: Only one person from each firm should complete the 2023 Dues Renewal form.

General Information
This section must be completed in order to register online
Business Name:
Contact Name:
Phone Number:
Email:
Today's Date:

Membership Information

Please fill in or select each line that applies to your firm.

Voting Member:

(based on # of employees in all of your Texas offices,
including branch offices)

1-10 employees - $1100
11-30 employees - $1650
31-50 employees - $2100
51-75 employees - $2550
76-100 employees - $3000
101-150 employees - $4000
151-200 employees - $5000
201+ employees - $5500

Total# of Employees:

Provisional Member:

($1100 flat fee)

Affiliate Member:

($1200 flat fee)

Associate Member:

($1100 flat fee)

Late fee:

($50 if sent after 60 days)

Total Due:

Payment Information
Amount Due:	$
Payment Method:	Invoice Me (remit check) eCheck (ACH/eCheck) Credit Card

(Purple Book) Roster Listing

Please be sure to check your roster listing at www.tsla.org and let Jean jptsla@tsla.org know if any changes/additions or deletions need to be made. Please note that the TDI will not refer anyone in our purple book who is not licensed. Thank you for your renewal. We appreciate your continued support!

I've reviewed our current membership info on the TSLA web and found all to be in order.

I've reviewed our current membership info on the TSLA web and have the following changes:

Additional Comments

Please enter any additional comments in regards to this online submission.

TAX INFORMATION: Please note that dues are not deductible as charitable contributions for federal income tax purposes. Also, pursuant to the Revenue Reconciliation Act of 1993 fifty percent (50%) of your total dues for this year are a non-deductible lobbying expense and cannot be deducted as a business expense.

Please press Submit below to send your Membership Renewal to TSLA. Please review your information for accuracy before submitting this form. TSLA is not responsible for any incorrect information entered into this form.

You must check the box below in order to submit your registration:

I agree to allow TSLA to bill my credit card (if applicable) and have reviewed all info I have provided for accuracy.

Please use the Print Application button below to print
a copy of your Membership Renewal before submitting

and / or

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