Hands On Trade Association
Please fill out the Application below and submit your information to us on our secure server.
If you have any questions, please contact us at at 1-800-872-1282.
*All items marked with an asterisk are required fields.
Personal Information
*First Name:
Middle Initial:
*Last Name:
*Street Address:
*Zip Code:

Please maintain this E-mail address, it is used to Login to your personal account and is our primary way of contacting you.
*Re-enter Email:
*Home Phone (xxx-xxx-xxxx):

Please enter (-) between numbers.
Business Phone (xxx-xxx-xxxx):

Your business name will be used in your website address.
Your Business Name:
Your Website Address:

Your customers can use this address to visit your business website.
*Manual Therapy Specialty
(Ctrl + click for multiple):
Do you currently own a Professional Liability Policy?
Yes   No
If yes, with whom?
When does it expire? (mm/dd/yyyy)***

Please enter (/) between dates.
*** Your Hands On Policy will not be effective till this date
Your Hands On Trade Association membership term is 12 months.
The Hands On Trade Association is not responsible for discontinuing any prior insurance policy that you may have with another professional liability provider.
Membership Option
Hands On Trade Association Benefits Package includes Professional Liability (malpractice) and General Liability (slip & fall / premises) Insurance coverage with $2 million of protection per year with $3 million aggregate.

Choose your Membership type:
$155.00 Professional Membership
$75.00 Student to Professional Membership**
**(Students can sign up any time before they physically receive their license or certificate.)
Referred by

(*Required school name for students)
Additional Insured Option

An Additional Insured is additional coverage for a building owner, landlord, or business that you/a practitioner, may be employed at or renting space from.

An Additional Insured enjoys the benefits of being insured under an insurance policy, in addition to the purchaser of the insurance policy. It arises when you need to provide insurance coverage for additional parties.

An Additional Insured must be a business and cannot be another practitioner or individual.

A $10.00 dollar fee will be added to your membership for each additional insured added.

Payment Information
Name on card:
Credit Card Type:
Credit Card Number:

Please enter numbers only with no dashes or spaces.
Expiration Date:
Security Code:
Billing address same as address above.
Billing Street:
Billing City:
Billing State:
Billing Zip Code:
Authorization and Disclosure
I represent that the above statements are true and no material facts have been suppressed or misstated. I attest that, as of this date 06/24/2017 I have no knowledge of any allegation, claim or lawsuit or any act, error or omission, which might reasonably be expected to result in a claim or lawsuit.

I authorize coverage issuance and the above statement is true to the best of my knowledge.
I shall comply with Hands On Trade Code of Ethics.
I shall comply with the iWantaSpa Biz Builder Terms & Conditions.
I understand that this policy is only a liability policy and this policy will not cover my property or contents in any case.
I understand that the billing statement on my credit card will read "Hands On Trade" and that this authorization is nonrefundable.

Within minutes, you will receive an E-mail Confirmation of membership with a link to your insurance and benefits. The E-mail Confirmation will be sent to your E-mail address from: info@handsontrade.com

If you do not receive the E-mail, in your regular In-Box, please check your Junk, Spam or Bulk folders. Depending on your security settings, occasionally and mistakenly the E-mail can be directed there.

Nothing is sent to you through the mail.

Copyright ©2013-2017, Hands On Trade Association. All rights reserved.