National Coalition on Benefits

Thank you for your interest in joining the National Coalition on Benefits (NCB). You can join with our other members to work with Congress to maintain employers' ability to provide uniform health and retirement benefits to employees and retirees across state and local lines and to ensure that federal health reform initiatives preserve ERISA benefits. Please complete the form below to begin the membership process. Fields in bold are required.

Contact Information

	Organization Name:
	First Name:
	Last Name:
	Title:
	Phone Number:	Ext.
	Email Address:
	Fax Number:

Secondary Contact Information

	First Name:
	Last Name:
	Title:
	Phone Number:	Ext.
	Email Address:
	Fax Number:

Indicate whether the NCB has permission to link to your company’s/association’s website (You may respond to this later if it would mean a delay in joining)
	NoYes, Provide Link: http://
Is your Company/Association willing to be publicly listed on Coalition letters and website? (You may respond to this later if it would mean a delay in joining)
	NoYes, indicate how it should be listed if different from above
Is your company/association willing to be contacted by the Media?
	NoYes
Indicate the Committees you are interested in participating in:
	Communications Lobbying Policy Legislative and Legal Development Membership Grassroots




For questions, email sonduck@businessgrouphealth.org.

Providing health insurance to more than 130 million Americans