Application
Please select your application:
I am a new applicant
I am renewing my application
  If renewing select policy renewal begin date:
Are you a member of AEA? (Check if YES)
Name (First Last):
Address:
City:
State, ZIP Code:
Email:
Home Telephone:
Work Telephone:
Fax:
 
Policy Choices & Premiums
LIMIT ANNUAL PREMIUM  
$1 million/$3 million $210.00 Per Instructor*
$1 million/$4 million $233.00 Per Instructor*
$1 million/$5 million $242.00 Per Instructor*
$2 million/$3 million $237.00 Per Instructor*
$2 million/$4 million $252.00 Per Instructor*
$2 million/$5 million $256.00 Per Instructor*
Do you own or lease a facility? Yes or No
(If the area excedes 1,000 sq. ft., call us first (800) 991-3080)
   
Provide Number of ADDITIONAL INSUREDS
First 10 FREE! $35 each thereafter.
(Additional Insured Includes: Landlords, Clubs, and Recreational Dept.)