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Event Insurance Form
Personal Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Event Information
Type of Event
*
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Date
*
-
Month
-
Day
Year
Date
Event Start Time
Event End Time
All Day Event
*
Yes
No
Other
Event Hosted by(Person or Organization)
*
Event Organinzer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Guests
*
Repeating Event
*
Please Select
No
Weekly
Monthly
Yearly
Are there water activities, amusement devices, inflatables, rides or animals?
*
Yes
No
Is there camping, sleeping overnight or events past 2am? (Remember to include the next day during date selection if an event passes 12am.)
*
Yes
No
How many golf carts, ATVs or UTVs will you or anyone under your direction be operating?
*
Will your event(s) be a political event, activist event, protest, rally or march?
*
Yes
No
Have you or anyone involved in the Event had more than one Event Liability Claims/Losses or any Event Liability Claim/Loss valued over $10,000 in the past five years?
*
Yes
No
Will you, the insured, your operations, your products, or your event participation have any involvement with cannabis or cannabis-related products?
*
Yes
No
Description of Event
*
How did you hear about us?
*
Optional Upload (Event Fliers, Invitaion, etc.)
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