Professional Liability Insurance

Application Note

Your application form and all other documentation pertaining to your policy will be available for viewing and printing at any time in your customer portal.

Personal Information

First Name
Last Name
Date of Birthmm/dd/yyyy
DAN Member ID
Non-Member
Agency
Agency IDno id, enter "99999"
Professional Status
Previous Claims?

What activities do you currently participate in:

--Scuba Instruction
--Assistanting Scuba Instructors
--I'm an Instructor in Training
--Divemastering
--I'm a Divemaster in Training
--Skin Diving Instruction
--Free Diver Instruction
--Swimming Instruction

Contact Information

Mailing Address
City
State
Zip/Postal Code
Country
United States
Email
Phone

Coverage Options

Effective Date

Select Start Date for Your Coverage
12:01AM ESTformat: mm/dd/yyyy
 
Coverage effective date begins at 12:01AM EST on the date selected. Coverage ends 1 year later at 12:01AM EST.