IFS General Sign Up

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MASA Enrollment by Insurity Financial Services

Choose Your Membership and Plan

MASA*

Yes, I want the peace-of-mind of MASA membership. I get pre-paid medical emergency assistance 24/7, 365 days of the year, anywhere in the world. When I choose the family option, my spouse is covered by the same benefits and I can add dependent children under age 18 at no additional cost (age 23 if full-time student).

ASBA Membership*

Please make me a complimentary ASBA member so I can take advantage of this valuable program for up to 40% off the regular price. I am already an ASBA member, please apply my discount.

Select Plan (Prices Reflect ASBA Discount)

MASA Platinum - Single - $27/month ($324/year) MASA Platinum - Family - $35/month ($420/year) MASA Elite 5 Year - Single - $1305/5 years MASA Elite 5 Year - Family - $1755/5 years MASA Charter Lifetime (50+) - Single - $2900 MASA Charter Lifetime (50+) - Family - $3900

Member Information

Member Name*

Member - Date of Birth*

Spouse's Name

Spouse - Date of Birth

Add Children to Policy?*

Yes No

How many children?

Child #1 Name*

Child #1 - Date of Birth*

Child #2 Name*

Child #2 - Date of Birth*

Child #3 Name*

Child #3 - Date of Birth*

Child #4 Name*

Child #4 - Date of Birth*

Child #5 Name*

Child #5 - Date of Birth*

Child #6 Name*

Child #6 - Date of Birth*

Address Line 1

Address Line 2

City

State

Zip Code

*If you reside in Washington or Wyoming please call 480-613-4118

Do you have a different Mailing Address

Yes

Address - Mailing

Address Line 1

Address Line 2

City

State

ZIP Code

Email Address*

Phone Number*

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship to Member(s)

Select Payment Type (Bank or Credit Card)

How would you like to pay?*

Bank Credit Card

Membership Level

You have chosen MASA Platinum - Single

$27/month ($324/year)

You have chosen MASA Platinum - Family

$35/month ($420/year)

You have chosen MASA Elite 5 Year - Single

$1305/5 years

You have chosen MASA Elite 5 Year - Family

$1755/5 years

You have chosen MASA Charter Lifetime - Single (50+)

$2900

You have chosen MASA Charter Lifetime - Family (50+)

$3900

Payment by Bank Account

Monthly Bank Draft (Platinum membership only) Agreement

I hereby authorize MASA-Medical Air Services Association to initiate a monthly debit to my checking or savings account at the depository financial institution named below and to debit or credit the same to such account. If this item is returned unpaid, I authorize an additional returned check fee in the conformity with the Policies of my financial institution.

Choose your recurring bank draft date (Day of each month)

Your first payment will be billed today, future payments will occur on the day of the month you choose.

Bank Name

Initial payment will be drafted immediately, and monthly thereafter on your chosen draft date

Checking Account Number

Routing Number

First 9 digits at the bottom of your check

Payment by Credit Card

The Platinum Membership automatically renews annually. You must notify MASA in writing if you wish to cancel your Platinum membership. MASA will contact you prior to your Elite 5 year membership renewal with options to continue.

Choose your recurring credit card draft date (Day of each month)

Your first payment will be billed today, future payments will occur on the day of the month you choose.

Credit Card

Monthly memberships automatically renew each month, unless member cancels prior to the start of the next month.

Credit Card Number

Expiration Date

00/0000 example (01/2025)

Security Code

3 digit code on back of card, Amex cards 4 digit code on front.

Authorization

Applicant Name*

Date/Time*

Where did you hear about us?

Mike Wendland - RV Lifestyle Facebook Google Referral Other