To apply and pay for membership, fill out the form below and when completed you will be forwarded to Authorize.net for payment, or if you are mailing in your application complete the printed application and send with payment to:
P.O. Box 246
Jefferson City, MO 65102
Missouri Businesses that self-insure workers’ compensation liability.
AFFILIATE MEMBERS (non-voting status)
Any person, firm, corporation, or private or public entity which is currently qualified as an employer as provided for in the
Missouri Workers’ Compensation Law which is also not currently a certified self-insurer, but which has insured its liability under
the Missouri Workers’ Compensation Law with a duly qualified insurer licensed to do business in Missouri, and which company
also has a minimum self-insured deductible amount of $250,000.00 for each claim with said insurance company, as provided for in
the Missouri Workers’ Compensation Law, shall be eligible for membership in the Association as an Affiliate Member.
ASSOCIATE MEMBERS (non-voting status)
Organizations (claims service agencies, attorneys, etc.) representing employers who are self-insured under Missouri law.