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BBB Accredited - Start with TrustAlternative Therapy Association
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Professional Application

Level
Professional Membership ($179.00 (USD)) Subscription period: 1 year Automatic renewal: no

IMPORTANT - PLEASE READ - THANK YOU 

ALL FIELDS* MUST BE COMPLETED OR YOU WILL NOT GO TO THE PAYMENT PAGE 

Your membership application includes professional and general liability all for the low price of $179.

Additional processing and additional insured options are available.
 

Re: Additional Insured 

Your membership will provide you with insurance as an individual only.

Often your landlord or place of work or tradeshow require that they be listed on your Certificate of Insurance as an Additional Benefit Holder specifically for your work. You may also choose to list your company name as the additional insured.

 

The Additional Benefit Holder is not for other professional providers as they must have their own individual policy.

There is a $10 charge for each additional insured. 

 

Once the below application is submitted you will be automatically sent to a secure payment page to complete the payment process and make your membership with insurance active.

 

Please DO NOT submit application if you are unable to make FULL PAYMENT after.

 

Your certificate of insurance is sent to the listed email address provided by you.

 

Thank you and Welcome!

Fill in application form

Application form

* Mandatory fields
 

 

*First name
*Last name
*E-Mail
**Re-enter E-mail
 

Contact Information

*Address
Address 2
*City
*State
*Postal code
*Home Phone#
Business Phone
Fax
*Password (make your own account password)
 
*Date of Birth
 

Trade/Services Information

*Therapies (check all that apply)
License/Certificate # (if required by state/local)
 

Additional Insured Option *PLEASE COMPLETE ALL *FIELDS

Additional Insured
Please list name, address, phone of EACH additional insured added and your relationship w/them.
 

Business Information

Self-employed
If yes, Business type:
 

Referral Information

Member Referral Credit
Other Referral
Referral Details (optional)
 

Processing Option (NOTHING IS SENT BY U.S. MAIL OR FAX UNLESS PAID HERE)

*Please choose processing options
Mail Address Option
Email Address Option:
or Fax # Option:
 

Terms of Use Authorization and Disclosure

*I Accept
Todays Date

Discount code

Enter discount code
Cancel
 

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