Wisconsin Council of Self-Insurers, Inc. Application for Membership
Please complete the below application in order to be considered for membership in WCSI.
Email address *
Company or Organization
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Designated Representative (First, Last)
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Designated Representative Title
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Mailing Address (House/Building #, City, State, Zip)
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Primary Phone
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Please Select Class of Membership
Please list the full-name and title for an additional person to receive notices and mailings:
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Please enter a mailing address for your additional representative (House/Building #, City, State, Zip)
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Please enter the email address of your additional representative
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Will you be paying your annual dues online or via check?
Paying Annual Dues Online
On the "Become A Member" page of the WCSI website select "Buy Now" underneath your respective membership class to pay your annual dues via PayPal or major credit card.
Paying Annual Dues Via Check
If you would like to pay your annual dues with a check, please make the check out to "Wisconsin Council of Self-Insurers, Inc." with your respective membership class amount listed. Please mail all checks to N14W23833 Stone Ridge Drive Suite 444, Waukesha, WI 53188.
A copy of your responses will be emailed to the address you provided.
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