Membership Renewal Form

 

Name:______________________________________________

Company:___________________________________________

Email:_____________________________________________

Phone Number:__________________________________________

* Membership Renewal Fee of $20.00 is due, payable to the Albany Claims Association, upon submission of this form. All renewal forms should be mailed to

Albany Claims Association c/o Alixanne Ruff

PO Box 14292

Albany, NY 12212-4292