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About Clarion : Association Application

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Endorse Clarion

Please note fields that appear with * are mandatory.

Association Name*
Contact Person*
Address*
City*
Country Name*
State Name*
Zip/Postal Code*
Phone Number*
Fax Number
EMail
Web Site URL
Number of Active members in the association*
In what countries do the majority members reside?
On a percentage basis, how many members are under the age of 26?
If you do not know, please estimate.
%
Annual membership fee
Is the purpose of the association strictly to purchase group insurance?* Yes No
Does the association currently have a musical instrument insurance program in place?* Yes No
If approved, will the association aggressively notify its members of this new insurance benefit?* Yes No
If approved, how would the association like the program to work?* Members would contact the association administrator to start coverage make changes. The association would pay the premium in full and collect from the individual member. The association would endorse Clarion and members will contact Clarion directly and the association will not have any involvement.

200 Motor Parkway Suite B10
Hauppauge, NY 11788-5113

clarion@clarionins.com

1-800-VIVALDI

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