Registration

Become a Self-Insurance Service Individual Provider Member

Become a selfinsurancemarket.com service provider member today and get the following benefits:

Entry in the selfinsurancemarket.com Service Provider Directory with full personal description.
Use the Provider Search Facilities to source new partners.
Let companies and other Service Providers source your specialist services and contact you when they need help.
Respond directly to companies who post Business Inquiries on the site.
Use our Risk Transfer Inquiry Service.
Create your own personal profile with unique URL and boost your visibility in search engines.

INDIVIDUAL SERVICE PROVIDER APPLICATION

Click here to see our membership information

Please enter a Username (7 -20 characters) *

Job Title *

Please enter a Password (7 character minimum) *

Company Name *

Confirm Password *

Company Address *

Title *

City *

First Name *

State, County or Province *

Last Name *

Country *

Email *This must be a business email which matches your employer

Zipcode or Postal code *

Phone *

Company Website (with http://) *

Twitter address (with http://) This can be your company's or your own

LinkedIn address (with http://) This can be your company's or your own

Page name format * This will create your own unique page at selfinsurancemarket.com which will show up in search engines. Please enter your personal name with hyphens in between separate words (e.g. first name-surname)

Business Inquiry Email (this is the email to which any inquiries will be sent) * This must be a business email which matches your employer

Become a Self-Insurance Service Individual Provider Member

INDIVIDUAL SERVICE PROVIDER APPLICATION

Select Membership

Select Membership