American Association for Respiratory Care
S.C. WEB AARC-197

Request for information only. With no obligation on my part, I'd like complete details about the insurance coverages checked below. (please print)

Name _____________________________________________________

Address ___________________________________________________

City ______________________________________________________

State ________________________________ Zip __________________

Daytime Phone (___________) _________________________________

Professional Liability (Employed Only)
Group Term Life
Professional Liability (for Self-employed members. Not shown)
Disability Income
Comprehensive Medical
Hospital Indemnity
Dental, Vision, Hearing & Prescription Drug Plans
Supplemental Cancer (Not shown)
Excess Major Medical (Not shown)

Please fax to: 1-312-427-1455

Or mail to:
Maginnis & Associates
Attn. Lead Desk
332 S. Michigan Avenue, Suite 1400
Chicago, IL 60604

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