Application for Group Liability Insurance - Per Event

May 1, 2014 – April 30, 2015

We also offer insurance at a flat rate for the year. See our Group Liability Insurance page for more about coverage and eligibility for each of our offerings. You may join either policy at any time; we cannot process requests the week of your event.

NOTE: Once you press Add to Cart, your insurance purchase will appear in the Shopping Cart module in the right sidebar and you can check out from there.

Contact Info

















Participation



Event Details

Please list the names and dates of your events, as well as the full address of the venue. (For a single-day event, enter the same date for start and end.)

Event #1









Event #2









Event #3









Event #4









Additional Insureds

Please supply the name and full address of each additional venue you wish to cover.









Premiums

Your total premium is automatically calculated below, based on the dates and insureds you entered above.

"Event day" is counted as a calendar day. For example, a dawn dance that starts on Saturday night and runs until Sunday morning counts as 2 days; a weekend from Friday evening through Sunday morning counts as 3 days.

event days   ×   $50   =   $
additional insureds   ×   $30   =   $
TOTAL   =   $

Please proceed through store checkout to finish submitting your application. We will contact you if we discover omissions or other problems with your application. Please allow at least 3 weeks for processing; we will forward the certificate of insurance when we receive it from the insurer.

NOTE: Once you press Add to Cart, your insurance purchase will appear in the Shopping Cart module in the right sidebar and you can check out from there.