ONLINE MEMBERSHIP APPLICATION

Than you for your interest in becoming a NCCIA member. Complete our online membership form below.

You also have the option to download the Membership Form and return via Standard Mail. You may either submit your membership payment online by CLICKING HERE or Mail us payment to the address below.

North Carolina Captive Insurance Association
151 Crest Road
Southern Pines, NC 28387
910-684-837

If you opt to complete the Online Membership Form below, you will be redirected to the NCCIA Payment Portal after submitting the form. 

If you are not redirected to the payment portal after submitting your online application, click the PAY NOW button below.