OHCA PEC Event Application

Otterhound Club of America, Inc. Application to Host the OHCA Public Education Event
This application is intended to collect information regarding an event hosted on behalf of the Otterhound Club of America, inc. to assure coverage through the OHCA Liability Insurance.
This Application is for:

Other
Year of the Event:

Other
Event Location

CityState
Event Start Date

MonthDayYear
From
Event End Date

MonthDayYear
To
Additional Information about the Event:
This Proposal is Submitted by:
Event Chair/Main Point of Contact

First NameLast Name
Event Chair - Email
example@example.com
Event Chair - Phone Number

Area CodePhone Number
Event Co-Chair/2nd OHCA Member

First NameLast Name
2nd Member - Email
example@example.com
2nd Member - Phone Number

Area CodePhone Number
OHCA Members That Will be Present at the Event:
First & Last Name(s)
Number and Names (if available) of Otterhounds expected at the Event:
Dog Name(s)
Additional Comments/Information
Are there any costs associated with the Event?
Cost Explanation/Funding Request
This Application will be submitted to Cindy Huffman. Please keep a copy for your records.
Please verify that you are human
Should be Empty: