Existing Members: Add Household Members

When you join Legacy Assurance, you earn the right to enroll up to four other family members (who live under the same roof as you) into the membership.

Submit this form to enroll up to four family members that live in the same household as you.

Name: *

First

Last

Email *

Member Number (On Membership Card): *

City: *

State: *

Household Membership

Please let us know how many family members will be assigned membership.

How many family members in your household will be enrolled? *

Phone