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Requirements:

New members who joined the association within the past year, who are under age 60 and a U.S. resident, are eligible to
receive $25,000 of ACS Basic Group Term Life
Insurance and $15,000 of Accidental
Death and Dismemberment
coverage for one year at
No Cost to You!

New York LifeNew York Life
Insurance
Company
Enrollment
Contact Info

First Name: *
Last Name: *
Gender:
ACS Member ID#: *
ACS Membership Effective Date: * MM/DD/YYYY
Address: *
 
City:*
State:*
Zip Code: *
Home Phone:
Work Phone:
Date of Birth: * MM/DD/YYYY
Email: *
* = Required     Next Step
Contact Info     Beneficiary

First Name: *
Middle Initial:
Last Name: *
Relationship: *
Address: Lives Abroad? *
 
City: *
State: *
Zip: *
Abroad Location:
Lives in States?
View Popular Beneficiary Designations

Add Another Beneficiary
* = Required     Finish!
Contact Info     Beneficiary 1     Beneficiary 2

First Name:
Middle Initial:
Last Name:
Relationship:
Address: Lives Abroad?
 
City:
State:
Zip:
Abroad Location:
Lives in States?
Beneficiary Type:
Have more beneficiaries? <— Check here to receive a form by mail.
  View Popular Beneficiary Designations

Finish!
  © Copyright ACS 2010

Underwritten by New York Life Insurance Company, 51 Madison Avenue New York, NY 10010, under the Group Policy Form GMR-G-29200/FACE. Brokered and administered by Pearl Insurance, 1200 E Glen Ave, Peoria Heights, IL 61616.

A complete description of the ACS Group Term Life Insurance Plan is contained in the Certificate of Insurance. Benefits are provided under the Group Policy Form GMR-G-29200/FACE. The complete terms, limitations, exclusions and conditions will be set forth in the Group Policy issued by New York Life Insurance Company to the ACS Insurance Trust.