Account Registration

*Note: Membership to this site is public. Once your account information has been submitted, you will be granted immediate access to the site. All fields marked with a red asterisk are required. (Note: - Registration may take several seconds. Once you click the Register button please wait until the system responds.)

User Name:

Enter a user name. It must be at least five characters long and is must be an alphanumeric value.

Password:

Enter your password.

Confirm Password:

Re-enter the password to confirm.

Display Name:

Enter a display name.

Email Address:

Enter a valid email address.

First Name:

Enter a first name.

Last Name:

Enter a last name.

Date of Birth

Please provide your Date of Birth.

Open the calendar popup.

Member ID

Please refer to the bottom of the page on how to locate your AFSA member ID.

Secret Question

Please select a Secret Question.

Secret Answer

Please provide a Secret Answer

Email me about available products

I would like to receive new product information via email when available.

Postal Code:

Enter the Postal/Zip Code part of the address.

To register for an AFSA Member Insurance Program account, you will need your AFSA member ID number, which can be found on your AFSA member ID card. If you do not know your ID number or need further assistance, please call AFSA at 800.638.0594.