Request for Certificate of Insurance

Abrams Insurance Agency
Request for Certificate of Insurance
The Model A Restorers Club, Inc.
6721 Merriman Rd
Garden City, MI 48135
Name of Requesting Region:*
Full Official Name of Region
Phone Number:*
Please enter a valid phone number.
Date of Event:*

MonthDayYear
Approximate Number of Attendees:*
Type of Event:*
CTRL Click to enter multiple or enter below
If Type of Event is other:
Fill only if type of event is not listed.
Will Bleachers Be Used?*

YesNo
Location of Event:*

Street Address

Street Address Line 2

CityState

Zip Code
Owner of the Premises Where This Event Will Be:*
Held: Certificate to Be emailed To:*
example@example.com
Special Instructions:
Signed Contract?*

YesNo
A copy of any signed contract sent to the MARC OFFICE by any of the methods below.
Contract may be uploaded here.

See below for other methods.
Cancelof
Or

Email: marc-office@modelarestorers.org

Or

Mail:

The Model A Restorers Club
6721 Merriman Road
Garden City, Michigan 48135

__________________________________________________________________

This form should be submited to the Model A Restorers Club for approval at least

one month prior to the event.

(Use Submit Button Below.)
Should be Empty: