2026-27 Essential Protection Insurance Application
Have these ready before you continue:

• Membership level and any add-on coverage (keep the Coverage & Pricing page open for reference)
• The category(s) your services fall under
• Additional Insured details, if applicable (e.g. landlord)
• Credit card for payment
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Email *
First and Last Name
Must be your legal name.
 *
APC Member Number
If this is a new member application, put "New". Your member number will be assigned when processed. 
 *
Phone *
Address *
City, state, zip code
Please use 2-letter state abbreviation. 
 *
Business Name
Website Address
How did you hear about us? *
Applicant Eligibility

✔ U.S. Residency: Applicant is a resident and actively residing in the United States.

✔ Legal Compliance:  Applicant operates in compliance with all applicable state and local laws, including licensing and regulatory requirements.

✔ Training & Scope of Practice: Applicant is trained in the services they offer and practices within their documented scope of training.

✔ Professional Purpose: All services must be intended to support a client's personal growth, well-being, education, or coaching goals. Services performed solely for entertainment purposes (e.g., psychic readings, fortune telling) are not eligible for coverage.

If you do not meet these requirements, you are not eligible for the coverage offer through ACP.

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Required
Professional Services to be Covered
Please list ONLY services that will be covered by this policy. Excluded services are listed on the website. If your service is not listed, please verify coverage with us BEFORE filling out this application.
Coaching services offered. 
Check all that apply to your practice.
 *
Required
Additional Professional Services Covered 
Check all additional approved services you provide. Sevices listed on the APC website are pre-approved. 

If your service is not listed, please verify coverage with us BEFORE filling out this application.
 *
Required
Please list any devices used in your practice? 

Please note: any incident relating to the function, or malfunction of a therapeutic instrument is considered a product liability issue and is not covered by this policy. ONLY YOUR PROFESSIONAL LIABILITY IS COVERED.

Indicate N/A if not applicable.
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Applicant Disclosures 
Has a professional claim been filed against you in the last 5 years?  *
If YES, please describe claim filed against you 
Are you currently in a client situation that might result in a claim?  *
If YES, please describe that client situation. 

Member Agreements 

Click here to read all agreements.

✔ I agree to have my clients sign a client agreement that meets the APC requirements.

✔ I agree to abide by the APC Code of Ethics.

✔ I understand that the coverage applies only to the services covered by the policy.

✔ I have read and understand the policy exclusions. 

✔ I hereby state that I agree with these terms and conditions.

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Required
By signing, I affirm that all statements made by me on this application are true, correct & current. Type your full legal name as your electronic signature. *

Once you submit your application, you will not be able to make changes to it online. If you need to correct or update any information after submitting, please email us with your requested changes.

You may also request a copy of your submitted application by email.
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