2017 Annual Member Assessment

Please complete the 2017 Annual Assessment Form & return to Executive Director Sara-Becca Smith. Forms can be returned by email, fax, or mail.

Please also be sure to attach either the Annual Statement or the Exhibit of Premiums and Losses for each company to be covered.


Fax: 518.463.8656

1450 Western Avenue Suite 101
Albany, NY 12203