EmailMeForm
Application for Affiliate Membership
National Tax-deferred Savings Association
Membership in NTSA must be renewed annually.
Name
*
Prefix
First
MI
Last
Company:
*
(provide company name, even if home address is noted below)
Title:
*
Address Type:
*
Home Address
Business Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Work Phone
*
###
-
###
-
####
Home Phone
###
-
###
-
####
Home ZIP Code (for government affairs purposes):
Work Email Address:
*
Personal Email Address
Which position best describes your job function?
*
403(b)/457 Advisor
Wholesaler (External)
TPA
Home Office (Provider, Broker-Dealer)
Accountant
Attorney
Other
Company, Broker-Dealer or RIA Affiliation:
*
Company
Broker-Dealer
RIA Affiliation
Company Name:
Broker-Dealer Name:
RIA Firm Name:
What 403(b)/457 plan markets do you serve?
*
K-12
Healthcare
Religious
University/College
Government
Other
Code of Conduct:
Have you been found guilty of a felony, violation of insurance or securities regulations or any violation of the code of ethics of any professional or business
organization?
*
Yes
No
If yes, please explain.
*
*
I have read the NTSA Code of Professional Conduct and if my application is accepted I agree to abide thereby. I certify that the information provided in this application is true and correct to the best of my knowledge. The NTSA Code of Conduct can be found online: https://www.ntsa-net.org/footer/code-of-conduct/
Signature
Clear
Date:
*
MM
/
DD
/
YYYY
Membership Dues
Dues are paid on a calendar year cycle. Membership dues are prorated based on join date.
Select rate for affiliated with a Strategic Partner or not and then select the dues join date.
Membership Dues (Affiliated with a Strategic Partner):
*
Dues waived through 12/31/2025
Membership Dues (Not Affiliated with a Strategic Partner):
*
Jan 1 - Jun 30: $540 (dues through 12/31)
July 1 - Oct 31: $270 (dues through 12/31)
Nov 1 - Dec 31: $540 (includes next year’s dues)
$100 Retired or Government Employee (dues through 12/31)
I am paying by:
*
Check
Credit Card
Credit Card Type
*
Mastercard
Visa
Amex
Discover
Name as it appears on card
*
First
Last
Credit Card Payment
*
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
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Signature
*
Clear
Paying by check? Please print a copy of your completed application and send with check payment to: NTSA, P.O. Box 34725, Alexandria, VA, 22334-0725.
Questions? Please call us at 703-516-9300.
Tax Deductions:
Dues, contributions or gifts to NTSA are not deductible as charitable contributions; they may be deductible, however, as ordinary and necessary business expenses. Federal law prohibits a tax deduction for the portion of membership dues attributable to lobbying expenses incurred by the organization. Consequently, for 2025, 18% of your dues are non-deductible in accordance with this provision.
Total
$0.00
