Membership Application

* Required fields.

All NC Surplus Lines licensees are mandated by statute to be members of the NCSLA. The corporate entity is no longer required to be registered as a member — only the licensees associated with that agency/corporate entity.

An annual NCSLA Membership is valid from September 1st through August 31st.

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Add all Individual Surplus Lines Licensees associated with your specified Agency Location. Click the ADD LICENSEE button once all fields have been completed. Repeat the process to add additional licensees to the list. When finished, click the NEXT button.

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At least one licensee must be added.
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FIRST LAST SL LICENSE # EMAIL  
No Licensees Yet
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Review & Submit

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{{agencyName}}
FIRST LAST SL LICENSE # EMAIL
{{licensee.firstName}} {{licensee.lastName}} {{licensee.license}} {{licensee.email}}
{{paymentAmount}}
  • Membership does not go into effect until payment is received.
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Thanks for sending your application.

A payment of {{paymentAmount}} is due now.

Send your payment of {{paymentAmount}}, along with a copy of your Membership Application confirmation email to:

North Carolina Surplus Lines Association
8412 Falls of Neuse Rd, Suite 206
Raleigh, North Carolina 27615

Questions? Call: 919.746.8415

Thanks for sending your application.

A payment of {{paymentAmount}} is due now.

Pay for your membership online now: