The following form is for census purposes only. The Alliance of Independent Restorers is looking into a program to provide healthcare insurance to its members. Your information will not be used for any other purpose, except to collect information on the viability of a healthcare program through the Alliance of Independent Restorers.
Please include ALL persons you intend to insure (self, spouse, dependents, staff AND their dependents).
If you have any questions, please feel free to contact us directly.