Personal Information

Please Note: How you enter your name is EXACTLY how it will appear on your certificate of insurance. *All items marked with an asterisk are required fields.

Your free website will be available as soon as we process this application.

Select all that apply. If you practice Yoga Therapy, you must select it as your professional or other discipline here.

Yoga Therapists Acknowledgement

Insure LMT membership will be effective upon the effective date entered at the top of the form. Membership term is 12 months.

Insure LMT is not responsible for discontinuing any payroll/credit card allotment process you may have with any other Professional Liability provider.

Additional Insured Options

Additional Insured - An additional insured is a person or business entity protected by endorsement from the named insured's negligence. It is not meant to protect other practitioners.

Unlimited Additional Insureds Package

Throughout the span of your policy, you may likely have to add additional insureds. The cost of additional insureds can add up. Why not save this expense by purchasing the Unlimited Additional Insured Package?

 
Cost per Additional Insureds: $10 for 1 year and $15.95 for 2 year policy.

Insurance Plus Options

Insurance Plus provides professional and general liability insurance, $2 million per occurrence, $3 million annual aggregate, $2 million products and completed operations annual aggregate; $100,000 rental damage insurance; Identity Protection Plan; and $1,000 stolen equipment coverage.

Choose your program:

School Policy Requirements

  1. Only students enrolled in their initial license or certification course for the profession selected as primary modality qualify for a student policy.
  2. If you are not a student on the effective date of coverage, all insurance is null and void and no claims will be paid.
  3. Our student policies will only cover the discipline you are in school for when your coverage begins.

Continuing Education

Payment Information

Upon submission of this application, your policy becomes effective on the date selected above. Your payment will be reflected on your credit card statement this month. Your Annual payment may include $9.95 for a 1-year subscription to MASSAGE Magazine. Please note that you are covered for a 12 month period starting on the effective date you selected.


Insure LMT Insurance:
$159.99
Optional Magazine Subscription:
$0.00
TOTAL:
$javascript req'd
Insurance Plus Application - Credit Cards Accepted

Please no spaces


Check this if the billing address for credit card is the same as address above.

Authorization and Disclosure

I represent that the above statements are true and no material facts have been suppressed or misstated. As of this date, I have no knowledge of any allegation, claim or lawsuit or any act, error or omission, which might reasonably be expected to result in a claim or lawsuit. I further represent that, to the extent required, I am licensed to practice in accordance with all relevant federal, state and local requirements and my license is current and active. I understand and agree that I am covered for the modalities listed on the Insurance Plus website only to the extent that they are included in the scope of work as defined by the federal, state or local jurisdiction that regulates my professional activities. I acknowledge that the Effective Date of coverage must be either the application submission date or a future date. Applications cannot be submitted with an Effective Date of coverage that precedes the date of application. In addition, I acknowledge that professional services rendered under the influence of drugs or alcohol are excluded from coverage. I understand that if I am practicing Yoga Therapy, I have selected it as my profession or other discipline above.

Insurance Application PRIVACY POLICY: We respect and are committed to protecting your privacy. We may collect personally identifiable information when you visit our site. We also automatically receive and record information on our server logs from your browser including your IP address, cookie information and the page(s) you visited. We will not sell your personally identifiable information to anyone.
Insurance Application SECURITY POLICY: Your payment and personal information is always safe. Our Secure Sockets Layer (SSL) software is the industry standard and among the best software available today for secure commerce transactions. It encrypts all of your personal information, including credit card number, name, and address, so that it cannot be read over the internet.
Insurance Application REFUND POLICY: This is a fully earned policy, once this credit card payment is processed, there is no cancellation, refund or partial refund available. Please call our Customer Service at 1(800) 516-8822 with any questions.