First
Last
Street
Email
Phone #
Fax #
Type?
City
Current Membership Expires on:
###-###-####
Website
Position/Title
Member Type
Region
State
MM/DD/YYYY
Please fill out all fields most are required.
DPS LC#
Zip code
County
STOP
Company
DO NOT USE THIS FORM IF YOU ARE REGISTERING AS AN ASSOCIATE MEMBER
REGIONAL INFO
CT = Central Texas (austin) NT = North Texas (Dallas/Ft.Worth)
EP = El Paso (West Texas) GC = Gulf Coast (Houston)
SA = South Texas Alamo (San Antonio)
STATE = State Member (No Region)
RGV = Rio Grande Valley (South Texas)

Member Services

ASSIST Online NEW Membership Registration
COMPANY / SAFTEY GROUP / VENDOR MEMBERS ONLY      
If you are registering as an ASSOCIATE MEMBER please download this form, print and mail this form or contact your company administrator for more information

COMPANY / SAFTEY GROUP AND VENDOR MEMBERS - Please choose how you would like to register:
You may register ONLINE using your credit card. You may also choose to mail your payment in.

Registering online is quick, easy and secure!  Join ASSIST or renew your current membership in less than 5 minutes.  Pay your registration fee with your VISA, MasterCard, Discover or American Express card.

RENEWALS - IF YOU ARE RENEWING - CHECK THE CURRENT LIST AND SEE IF YOU ARE ON IT
IF YOU ARE ON THE CURRENT LIST SKIP THIS FORM
CLICK HERE TO PAY WITH A CREDIT CARD

For general information or questions regarding ASSIST membership and member services, please contact:

Alicia Beck
Member Services Director
Phone: (832) 274-1079
E-mail: memberservices@assisttexas.org

For all financial matters including your registration (whether made online or mailed-in), please contact:

Denise Nicholson
ASSIST State Treasurer
Phone: (254) 753-7766
Fax: (254) 662-9460
E-mail: treasurer@assisttexas.org

Membership Mail In Application and Payment Method

For Voting members who are not part of the workers comp safety group who wish to mail in their payment and application please download this form complete it and send it to the members services mailing address.

ASSIST MEMBER SERVICES
3300 BEE CAVES ROAD
STE 650-119
AUSTIN, TX 78746
Associate members must MAIL forms and payment - Vendor members who wish to mail in their payment and application please download this form complete it and send it to the members services mailing address.

ASSIST MEMBER SERVICES
3300 BEE CAVES ROAD
STE 650-119
AUSTIN, TX 78746
Click here to download the Employee Deduction Application (PDF)
Copyright © 2011 Associated Security Services and Investigators of the State of Texas, Inc.  All rights reserved.
The Success Story Continues as members of the El Dorado/ASSIST Workers’ Compensation Purchasing Group earn dividends for the 6th consecutive year
The Success Story Continues as members of the El Dorado/ASSIST Workers’ Compensation Purchasing Group earn dividends for the 6th consecutive year!
(View PDF, 156Kb)

ASSIST MEMBER SERVICES
3300 BEE CAVES ROAD
STE 650-119
AUSTIN, TX 78746
Alicia Beck
Member Services Director
Phone: (832) 274-1079
E-mail: memberservices@assisttexas.org