Enrollment in our programs is a very simple process. If you are ordained as a Deacon, Priest or Bishop in The Episcopal Church and live or are canonically resident in Pennsylvania, simply complete this form and submit it to us.

Application for Enrollment

Amount of Insurance Requested: Free $1,000 Introductory Policy

I hereby declare that the answers above on this Application are complete and true and correctly recorded to the best of my knowledge and belief. I agree that the declarations and statements on this application shall be the basis of the contract between the said Corporation and myself; and that this Application and any Policy that may be issued shall be subject to defeasance and all the provisions stated or contained in the By-Laws of the Corporation.