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Additional Information
Additional Information
Membership dues are non-refundable.
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Type of Business
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Broker/Consultant
Captive Insurance Company/RRG
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By submitting payment, I am authorizing Self-Insurance Institute of America, Inc. to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Self-Insurance Institute of America, Inc., or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.
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