Get Insurance Program Enrollment Form 2012-2013 - Constant Contact

Filling out the Insurance Program Enrollment Form 2012-2013 is an essential step for your PTA to ensure coverage and compliance. This guide provides clear, step-by-step instructions to help you complete the form efficiently and correctly.

Follow the steps to fill out the form successfully.

1. Press the ‘Get Form’ button to access the document and open it in the designated editing tool.
2. Enter your PTA name in the designated field to identify your organization.
3. Specify the region where your PTA operates, ensuring accurate information is provided.
4. Fill in the school address, including street, city, state, and zip code, to pinpoint your location.
5. Input the date of the application to ensure timely processing.
6. Provide your email address for communication regarding the insurance process.
7. Include the school phone number to facilitate any necessary contact.
8. Enter your name and title in the provided fields to authorize the application.
9. Sign the form to acknowledge agreement to the terms outlined in the application.
10. If applicable, provide the unit president’s name for additional verification.
11. Select the desired insurance options by checking the appropriate boxes for the Mandated Insurance Program, Property Insurance, and Accident Medical Insurance.
12. Indicate the total enclosed and check number to process your payment.
13. After reviewing all entered information for accuracy, save changes, download, print, or share the completed form as needed.

Complete your Insurance Program Enrollment Form online to secure coverage for your PTA.