By enrolling in the program, I hereby acknowledge that I have read and agreed to all terms and conditions as stated in the Certificate of Insurance.  I understand that employment at my sponsoring employer and/or membership in my sponsoring organization are required to enroll and/or maintain coverage in the program. I further understand that I must report any termination of my sponsoring employer and/or sponsoring organization membership to the insurance company listed in the Certificate of Insurance for cancellation of coverage.  I understand and agree that any failure to notify the insurance company of such termination and cancellation will preclude me from any coverage under the Certificate of Insurance as of the effective date of termination.