Online Renewal for Reflexology Insurance

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Renew your RAC Coverage Online

Renewing online is fast and easy! Your policy must be renewed prior to the expiry date.
If you have had a change of address or other critical information since your last renewal please click HERE and fill out the Change Of Essential Information Form before filling out this application.

* Choose one of the following 2 options:
Price: $243.00 Ontario ($200 + $25 policy fee + 8% PST) Price: $225.00 (All other provinces $200 + $25 policy fee)
* Designates mandatory fields. These MUST be filled in. If you have no email address please enter "none" and you will NOT receive email notification of this transaction.
Business name (if applicable)
First Name	*
Last Name	*
Street Address	*
City	*
Province	*
Postal Code	*
Phone Number with Area Code	*
Fax Number with Area Code
Email Address	*
Verify Email Address	*
RAC Registration Number	*
Do you practice any modalities other than Massage Therapy?
No Yes
Do you sell any products?
No Yes
Do you have any knowledge or information of any negligent act, any error or omission, or breach of duty that might give rise to a claim against you, or any reason to anticipate that a claim might be brought against you?
No Yes
If Yes to any of the above, please provide details below:

I am an active member in good standing with the Relexology Association of Canada. By submitting this application, you attest that the application has been completed accurately and honestly. No disciplinary action has been taken or is pending against you. You have never been the subject of any investigation, either civil or criminal, in connection with any sexual act, conduct, molestation, and/or assault. You understand that your insurance certificate will provide evidence that you have been added as an individual participant with respect to the coverage and limits of the Master Policy. You understand that the coverage provided by your insurance certificate is subject to all the terms, conditions and exclusions contained in the Master Policy. You further understand that the Insurance Company will rely on the information you have provided in the application. Failure to pay required premiums and/or false statements on this application or subsequent renewals shall void this application and render your insurance coverage null and void, and you may be subject to further legal action for making false statements. I Disagree I Agree
* Note: This is just an order form; it does not confirm insurance. If you require immediate documentation please provide your fax number. Your policy must be renewed prior to the expiry date. If your expiry date has passed please contact the office at 1-877-RMT-CANADA (1-877-768-2262).

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