GSIA Membership Application



GSIA has worked diligently to assure that self-insured employers are represented in every aspect of the workers compensation process. With the help of all our members, we have been able to ensure continuous improvement in the workers compensation process, while maintaining a reasonable cost.

Annual dues for GSIA members are based on the number of employees each member has in Georgia.

  • 1 to 300 employees $300/year
  • Over 300 employees $440/year
Please make check payable to: Georgia Self Insurers Association, Inc.
233 Peachtree St., Suite 2000
Atlanta, GA 30303

NOTE: Dues to GSIA are not deductible as a charitable contribution, but may be deductible as an ordinary and necessary business expense. However, 40% of your dues is not deductible due to GSIA lobbying activity. Insured employers are eligible to join GSIA as associate members.

If you have any questions, call 404-223-2285 or contact us here.
Greeting:
Name:
Company Title:
Business Name:
Address:
City:
State:
Zip
Email:
Work Phone
Fax Number
Number of Employees in GA:
Select Membership Type:
Associate Member: Insured employer or service provider to employers
Regular Member: Self insured under workers’ compensation law in Georgia or covering its workers’ compensation obligations through commercial insurance with a deductible of $100,000
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