IMPORTANT NOTICE

These programs are only available to current Mississippi Forestry Association members in good standing. Insured hunt club and landowner must provide their MFA member number.

Copies of all policies are on file with the Mississippi Forestry Association and are available from AssuredPartners upon request.

Questions concerning Mississippi Forestry Association memberships should be directed to Mississippi Forestry Association at (601) 354-4936 or membership@msforestry.net.

All questions relating to insurance coverage should be directed to AssuredPartners. Contact the Hunt Club and Timberland Department at hunting@assuredpartners.com or (803) 732-8452.

IF NOT APPLYING ONLINE: Separate checks must be written to AssuredPartners and

Mississippi Forestry Association.

Check #1: The insurance premium must be payable to AssuredPartners. (Refer to rates on

insurance application.)

Check #2: Mississippi Forestry Association dues must be made payable to Mississippi Forestry Association. (Refer to MFA Membership Dues Schedule.)

COMBINED PAYMENTS ON ONE CHECK WILL BE RETURNED

MAIL ALL CHECKS AND FORMS TO:

Mississippi Forestry Association620 N. State Street, Suite 201

Jackson, MS 39202

Membership qualifies you for Hunt Club andTimberland Liability Insurance programs

through AssuredPartners (formerlyDavis-Garvin Insurance Agency).

Both the hunt club and landowner mustbe current members of the

Mississippi Forestry Association.

Landowners Membership Dues(Based on forest acreage)

Up to 250 acres ... …$ 55.00

251 - 500 acres …….$ 65.00

501 - 1000 acres ..…$ 75.00

1001 - 2500 acres…….$100.00

2501 acres and above $55.00 plus .022

per additional acre over 100 acres

Hunt Club Membership Dues

Hunt Clubs .................... $ 72.00 per clubFor more information please visit

w w w . m s f o r e s t y . n e t

You may also contact the Mississippi ForestryAssociation if you have questions or torequest a membership application at

(601) 354-4936

or

membership@msforestry.net

Join theMississippi Forestry Association

today!

w w w. m s f o r e s t r y. n e t

H u n t C l u b & T i m b e r l a n d L i a b i l i t y

I n s u r a n c e

formerly

MFA membership must be processed prior to applying for insurance.If paying online at www.msforestry.net, please wait 48 hours before applying online for insurance.If mailing fees to MFA, Please wait 4 days before applying online for insurance.

Insurance may now be purchased online for instant proof of coverage!

Visit www.insurehuntclub.com to obtain an instant insurance quote.

*MFA member numbers required for hunt club and all landowners*Pay online with check, debit or credit card*Receive certificates of insurance via email instantly upon completion of onlineliapplication and payment

Circle one

Any commercial or business operations of any kind conducted on the premises?......................................... Y N

Any of this property leased for farming? ........................... Y N

Any of this property leased for hunting (private or commercial)? .............................................. Y N

If yes to any of the above questions, do you require them to secure coverage elsewhere and provide a certificate of insurance naming you as additional insured? ............. Y N

Any of this property ever used for mining or containing gas or oil wells ............................................. Y N

Circle one

Is this property fenced or posted? .................................. Y N

Any lakes or ponds on this property? ............................. Y N

Any dams / spillways / bridges on this property? ........... Y N

Any watercraft or docks on this property?...................... Y N

Any buildings, structures, towers or housing accommodations on this property? ............................ Y N

If yes, where are building, structures, towers or housing accommodations insured?

__________________________________________________

A p p l i c a t i o n — T i m b e r l a n d L i a b i l i t y I n s u r a n c e

Landowner Name _________________________________________________________________________

Contact Name __________________________________________ MFA Member# ____________________

Address _________________________________________________________________________________

City _________________________________________________ State ______________ Zip ____________

Telephone (Work) _____________________ (Home) _____________________ (Cell) _________________

Location (County) _______________________________ Number of Acres ___________________________

How is the property used ___________________________________________________________________

Describe any past losses ____________________________________________________________________

Premium Calculation --- Timberland Liability Insurance

Number of Acres to be covered ______________ X .23 cents per Acre = $ ______________________(Subject to $160 Minimum Premium) Client Code: MISSFOR-01

Signature of Landowner ___________________________________________________________________

Please make check for insurance payable to AssuredPartners

Coverage is subject to approval by AssuredPartners. Master Policy effective date is July 1, 2018 to July 1, 2019. Applications received after July 1, 2018 will be effective upon approval and will expire July 1, 2019.

T y p e o f I n s u r a n c e :

Comprehensive General Liability

Limit of Liability: $1,000,000 Each Occurrence $2,000,000 Aggregate

Named Insured: Mississippi Forestry Association - Timberland owners who are current members of the Mississippi Forestry Association

Special Master Policy rating basis

Master Policy to be maintained with the Mississippi Forestry Association

Liability coverage for the Landowner does not provide protection for owned timber

Standing Timber coverage is available for fire, lightning, wind, flood, ice and theftfor owned timber

Policy does not cover physical damage to, or liability in connection with buildings,structures, towers or housing accommodations

Timberland owners are required to be a member of the Mississippi ForestryAssociation

Timberland Liability Insurance

A p p l i c a t i o n — H u n t L e a s e L i a b i l i t y I n s u r a n c eYour Hunt Club Name _____________________________________________________________________

Contact ___________________________________________ MFA Member # ________________________

Address ________________________________________________________________________________

City ___________________________________________ State ___________________ Zip ____________

Telephone (Work) ____________________ (Home) _____________________ (Cell) _________________

If leasing from more than one landowner, please attach a separate sheet with the information requested

below for each landowner.

Landowner Name _________________________________________ Number of Acres ________________

Address __________________________________________ MFA Member# ________________________

City ___________________________________________ State ___________________ Zip ____________

Telephone (Work) ____________________ (Home) _____________________ (Cell) _________________

Location of property as described on lease ____________________________________________________

Premium Calculation --- Hunt Lease Liability Insurance

Number of Acres to be covered ____________ X .15 cents per Acre = $ ____________________(This line subject to $160 minimum premium)

Total Number of Insured Landowners _______ X $30each = $ ____________________Total Amount Due for Hunt Lease Liability Insurance = $ ____________________

Client Code: MISSFOR-01

Signature of Hunt Club Representative _______________________________________________________

Please make check for insurance payable to AssuredPartners

Coverage is subject to approval by AssuredPartners. Master Policy effective date is July 1, 2018 to July 1, 2019. Applications received after July 1, 2018 will be effective upon approval and will expire July 1, 2019.

T y p e o f I n s u r a n c e :

Comprehensive General Liability

Limit of Liability: $ 1,000,000 Each Occurrence$ 2,000,000 Aggregate$ 100,000 Fire Damage Liability$ 5,000 Medical Payments

Named Insured: Mississippi Forestry Association - Member hunt clubs leasing landfrom Mississippi Forestry Association member landowners

Separate certificates will be issued to each hunt club

Special Master Policy rating basis

Master Policy to be maintained with the Mississippi Forestry Association

Landowners may be listed as an additional insured

The club must have a written lease with all landowners listed on this applicationfor coverage to apply

MFA Member #’s are required for both Hunt Club and Landowners

Hunt Lease Liability Insurance