Membership Application
Have you already applied?
1. Choose your Membership
Basic
Individual
(9.95 monthly/$119.00 annual)
Couple
($13.95 monthly/$167.00 annual)
Defender
Individual
($14.95 monthly/$179.00 annual)
Couple
($19.95 monthly/$239.00 annual)
Ultimate
Individual
($34.95 monthly/$399.00 annual)
Couple
($41.95 monthly/$479.00 annual)
(*) Rates shown include all applicable premiums, taxes, and fees.
2. Choose your Payment Term
Annual
Monthly
*
3. Confirm Your Information
Applicant Information
Existing SCD Members – please provide Member ID #
(front of SCD membership card)
First Name
*
MI
Last Name
*
Address
*
City
*
State
*
--Select One--
AA ARMED FORCES AMERICAS (EXCEPT CANADA)
AE ARMED FORCES EUROPE/MIDDLE EAST/ AFRICA/CANADA
ALABAMA
ALASKA
AMERICAN SAMOA
AP ARMED FORCES PACIFIC
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DIST. OF COLUMBIA
FEDERATED STATES OF MICRONESIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARSHALL ISLAND
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
NORTHERN MARIANA ISLANDS
OHIO
OKLAHOMA
OREGON
PALAU
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
US VIRGIN ISLANDS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip
*
Phone
*
Cell Phone
Email
*
Gender
*
Male
Female
Date of Birth (MM/DD/YYYY)
*
Spouse Information
First Name
*
MI
Last Name
*
Gender
*
Male
Female
Date of Birth
*
4. Complete This Questionnaire
Second Call Defense pioneered the “Rapid Response” concept, offering legal and financial protection IMMEDIATELY after you use a gun in self defense. Our process depends on having key information at the ready when you call. In addition to the basic name and address information which you have already provided, we ask that you answer the questions below. We will regard this information as private and keep it securely on file for use in the event you call us in an emergency.
Memberships
*
Please check all that apply
NRA
Second Amendment Foundation
Gun Owners of America
State Organization
Local Gun Club or Range
Other
Legal Background
*
Have you ever been the subject of a lawsuit, criminal investigation, civil proceeding, or other legal action due to the use of a firearm?
You
Yes
No
Your Spouse
Yes
No
Please provide details
Permits and Licenses
*
Second Call Defense and our members must abide by the federal, state, and local laws in each state. Please check all that apply to you in your primary state of residence. Or check "N/A" if none are applicable in your state.
Registration Requirement
Secure Store Requirement
Permit/License to Own or Possess
Permit/License to Transfer
Permit/License to Purchase
Out of State Concealed Carry Permit/License
State
Resident Concealed Carry Permit/License
State
N/A
Please Explain
Emergency Contacts
In an emergency, we may need to contact family members or friends about your situation.
Please list one or two people we may contact:
Primary
Contact Name
Relationship
Home Phone
Cell Phone
Email Address
Secondary
Contact Name
Relationship
Home Phone
Cell Phone
Email Address
Recruiter Information
If you were referred by a Second Call Defense Recruiter, please provide Name and ID#
Recruiter Name
Recruiter ID #
Promo Code
THE APPLICANT WARRANTS THAT THE STATEMENTS AND RESPONSES TO THE QUESTIONS ON THIS APPLICATION ARE TRUE AND COMPLETE. THE SUBMITTAL OF THIS APPLICATION DOES NOT BIND THE COMPANY TO OFFER NOR APPLICANT TO ACCEPT INSURANCE, BUT IT IS AGREED THAT THIS APPLICATION SHALL BE THE BASIS OF THE INSURANCE APPLIED FOR. ANY SUCH INSURANCE ISSUED BY THE COMPANY AND ACCEPTED BY THE APPLICANT MAY BE CANCELLED BY THE COMPANY FROM INCEPTION UPON DISCOVERY THAT THE INSURANCE WAS OBTAINED THROUGH ANY FRAUDULENT STATEMENT, OMISSION, OR CONCEALMENT OF ANY FACTS MATERIAL TO THE ACCEPTANCE BY THE COMPANY OF THE RISK OR HAZARD ASSUMED.
Accept
*