Page 20 - Tree Line - North Carolina Forestry Association - Fourth Quarter 2022

PLEASE FILL OUT AND RETURN WITH PAYMENT
NOTE: This form is for NEW hunt clubs. Existing clubs and landowners need to contact the NCFA office at (800) 231-7723.
In order to obtain a hunting lease or timberland insurance, all parties have to be a member of the NCFA.
NCFA’s Hunting Lease
Liability Insurance Application
NAME OF HUNT CLUB: __________________________________________________ # of Members: ___________ Club Official to Receive Certificate of Insurance: ____________________________________________________ Mailing Address: _______________________________________________________________________________ City:____________________________________________ State:______________ ZIP Code:________________ County: _______________________________________________________________________________________ Work Phone:_____________________________________ Home Phone: _________________________________
Dues: $75 Payment Enclosed
Please check here if annual dues have already been paid.
NOTE: no coverage is in effect until all money is received by the NCFA. Coverage cannot be back dated.
NAME OF LANDOWNER (person, partnership or corporation):____________________________________________ Landowner Representative (If different from above):__________________________________________________ Mailing Address: _______________________________________________________________________________ City:____________________________________________ State:______________ ZIP Code: ________________ County: _______________________________________________________________________________________ Work Phone:_____________________________________ Home Phone: _________________________________
Dues: $50 Payment Enclosed (plus $.025 per acre for acres over 500) Please check here if annual dues have already been paid.
LAND INFORMATION
Total Number of Acres: ___________________ County: _____________________________State: ___________
HUNTING LEASE RATES (please check one) ✔
✔
ACREAGE RANGE
$1 MILLION PLAN PREMIUM FOR CLUB
$2 MILLION PLAN PREMIUM FOR CLUB
ACREAGE RANGE
$1 MILLION PLAN PREMIUM FOR CLUB
$2 MILLION PLAN PREMIUM FOR CLUB
Less than 500
1001-1500
$200.00 $370.00
$280.00 $520.00
3001-3500
4001-4500
$575.00
$740.00
$1,065.00
$1,370.00
2501-3000
$495.00
$915.00
3501-4000
$650.00
$1,205.00
501-1000
$235.00
$435.00
1501-2000
$360.00
$670.00
4501-5000
$775.00
$1,435.00
2001-2500
$440.00 $815.00
More than 5000
$0.15 Per Acre
$0.28 Per Acre
18 ncforestry.org / FIRST QUARTER 2022