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Membership Application Form
 Membership Application Form in Adobe Acrobat format.
Regular Membership
Regular membership in the West Virginia Self-Insurers Association offers firms, corporations and individuals an active voice as a self-insurer under the West Virginia Workers' Compensation Law. Regular members may vote on the membership of the Board of managers at each annual meeting. Additionally, only regular members may vote on the Association's constitutional and business issues.
Associate Membership
Associate membership is available to regular subscribers, including firms, corporations and individuals representing self-insurers in workers' compensation matters in West Virginia.
Associate members are not eligible to vote on constitutional and business issues.
Membership Fees
Dues are based on the average number of employees in West
Virginia during the preceding calendar year. Parent, subsidiary, or
affiliated corporations which are members of this Association may elect to
pay dues as a single unit based upon the combined total average number of
employees covered by Workers' Compensation in the state of West Virginia
during the previous calendar year as follows:
| Less than 1,000 employees |
$500.00 |
| 1,000 - 1,999 employees |
$700.00 |
| 2,000 - 3,999 employees |
$800.00 |
| 4,000 and up |
$900.00 |
| Associate Members |
$300.00 |
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