Enrollment - NRA Approved Service

Name*

First Name * Last Name *

NRA Membership ID

Member Type*

Email Address*

Address*

‎ ‎ City State Zipcode

Phone

Your No Cost Patriot Protection Plan ($5,000 Accidental Death for Regular members, $10,000 Accidental Death for Life members) has been pre-selected. Provide required member details and choose whether or not you’d like Expanded Accidental Death benefits*.

*Not available in all states.

Member Date of Birth*

Member Gender*

Male

Female

Expanded Accidental Death benefits

If you’d like to increase your protection by adding EXPANDED coverage, select an option below. Benefits reduce by 50% at age 75, regardless of age at enrollment.

Add Spouse

Spouse coverage will be equal to member's Expanded Accidental Death benefit amount. Please note that your No Cost Patriot Protection Plan does not extend to your spouse.

Spouse Name*

Spouse First Name * Spouse Last Name *

Spouse Date of Birth*

Spouse Gender*

Male

Female

The rates quoted are based on age as of today. Your premium shown on your bill will reflect your age as of your effective date and may differ from above.

Payment Method

Bank Transfer $1.25 processing fee

Credit Card $3.00 processing fee

Please enter your Member Number to continue to the site

NO-COST Patriot Protection Plan

Life Insurance

Personal Insurance

Emergency & Accident

Property & Liability