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What name is your policy under?*
Contact Name*
First Last
Email*
Enter Email Confirm Email
Please provide your policy number (if available)
Name of event*
Start Date of event*
Date Format: MM slash DD slash YYYY
End Date of event*
Date Format: MM slash DD slash YYYY
Description of event*
Is the event Indoors or Outdoors?*
- Indoors
- Outdoors
Will there be an inflatables at this event?*
- No
- Yes, we are listed as additional insured on the insurance of the company providing them
Any inflatables (bounce houses etc.) must be provided by a company with their own insurance and list you as additional insured in order to meet approval.
Budget*
Name of venue*
Address of venue*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of spectators*
Number of participants*
Event Coordinator Name (if available)
First Last
Event coordinator email (if available)
Any celebrities attending?*
- Yes
- No
Please give names of any celebrities attending
Please provide any special wording, certificate holder information or special requirements:
Comments
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