Applications are available here in PDF Format. In order to open and view the application you must have Adobe Acrobat Reader installed on your computer. It may take a few minutes for your computer to launch Acrobat Reader and open the file. If you would rather have one mailed to you, please use the contact information below to make your request.

If you wish to have an application faxed or e-mailed to you, please contact our office at (800) 882-4410 and ask to speak to a representative.

Standard Membership

Standard membership is included in all levels of E&O insurance coverage.

Directions

1. Fill out the appropriate application online. You can use the TAB key to navigate through the pages, or usethe mouse.
   
2. Print out the application once you are finished entering all the information.
   
3. Review all sections to insure accuracy of information.
   
4. Sign and date where needed.
   
5. Mail the ORIGINAL application with payment. Be sure to include all necessary items from the checklist onpage 1.
   
6. Applications are processed in 5-7 business days from the time it is received in our office.

Need Help?? Call 800-882-4410 and ask to speak to a representative