Application For Membership
This Application is for:
2010 - 2011 Policy
April 25, 2010 to April 25, 2011 - $210.00 per person
October 25, 2010 to April 25, 2011 - $150.00 per person
Note: This reduced premium option will be processed one week prior to the start date.
January 25, 2011 to April 25, 2011 - $110.00 per person
Note: This reduced premium option will be processed one week prior to the start date.
March 25, 2011 to April 25, 2011 - $50.00 per person
Note: This reduced premium option will be processed one week prior to the start date.
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Single Event - $125.00 per person (Limited to 7 Consecutive days)
Dates of event:
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2009 - 2010 Policy
March 25, 2010 to April 25, 2010 - $50.00 per person
Fill in the information below COMPLETELY.
Print out the application & mail with your check.
Make your check or money order made payable to Performers of the U.S.
Note: Hypnotists MUST also include a safety class certificate of completion with the application.
Mail to: Specialty Insurance Agency
P.O. Box 24
New Richmond , WI 54017-0024