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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 self-insured firms, corporations or high deductible insured employers an active voice in the promotion of fair and balanced WV Workers’ Compensation Law. Regular members may vote on the election of the Board of Managers and on WVSIA’s constitutional and business issues at the annual meeting.
Associate Membership
Associate membership is available not only to firms, corporations and individuals representing self-insurers in workers' compensation matters in West Virginia, but also to other businesses concerned with maintaining a balanced workers’ compensation system.
Associate members are not eligible to vote.
Membership Fees
Dues are based on the 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
number of employees. Fee structure is as follows:
| Less than 1,000 employees |
$600.00 |
| 1,000 - 1,999 employees |
$800.00 |
| 2,000 - 3,999 employees |
$900.00 |
| 4,000 and up |
$1000.00 |
| Associate Members |
$350.00 |
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WVSIA.com