Post Event & Waiver Processing

POST EVENT PROCESSING SUBMISSION

EVENT WAIVER UPLOAD
EVENT NAME:*
EVENT START DATE*
EVENT ORGANIZER*
CONTACT NAME*

First NameLast Name
CONTACT EMAIL *
Confirm Email
SELECT ONE*

Less than 18 PARTICIPANTSMore than 18 PARTICIPANTS
18 OR LESS PARTICIPANTS - Minimum Premiums apply

CLASS I-II - $100CLASS III - $110CLASS III-IV - $125WORKSHOP/TRAINING CAMP/CRUISE/CANOE/KAYAK CAMPING - $100BIATHLON $150TRIATHLON $180ERG - INDOOR/OUTDOOR- less than 30 participants $70
# - Participants (-18) *
18 OR MORE PARTICIPANTS PER PARTICIPANT*

Racing Event Class I-II - $5.50 PPRacing Event Class III - $6.10 PPRacing Event Class III-IV - $6.70 PPCruising/Training Camp/Workshop/Canoe-Kayak Camping/Kayak Angling - $5.20 PPBiathlon - $7.80 PPTriathlon - $9.40 PPErgometer 30 or more participants - $3.45 PP
# Participants*
BASE PREMIUM Due
POST EVENT PROCESS COMPLETED*

WITHIN 14 DAYS AFTER EVENTMORE THAN 14 DAYS AFTER EVENT ($20 late fee will apply)
YOU MUST ENTER THE NET PER PARTICIPANT PRE PAID AMOUNT. DO NOT INCLUDE THE PRM MEMBERSHIP, ADDITIONAL INSURED OR ONLINE PAYMENT PROCESSING FEES.

If you are not sure please check the original email for the Post Event Form sent with your certificates for the correct amount.
PRE-PAID NET PER PARTICIPANT PREMIUM- SEE ABOVE*
Do not enter prepaid premium as a negative the system will auto calculate.
If amount below is a negative number this will be your refund.
TOTAL DUE/REFUND
NAME & ADDRESS OF REFUND RECIPIENT: If your deposit premium was paid via Epay we will attempt to refund overpayments back to the payment method used. In the event we cannot please enter an alternative name and address for check.

Name

# & Street/PO Box

CityState / Province

Postal / Zip Code
IF ADDITIONAL PREMIUM DUE PLEASE INDICATE PAYMENT METHOD

CHECK BY MAIL: Must be received within 10 business days. Make payable to Paddlesport Risk Management, PO Box 668, Kings Park, NY 11754ONLINE - You will be directed to our main menu, upon submitting this form, to make your payment
PLEASE CHECK ALL THAT APPLY.

All boats, PFD's, bailers were checked prior to event and found to be sufficient, in good condition to be used and accessible to all participants/teams.To the best of my knowledge no Incidents/accidents occurred during the event.Pre-race Safety meeting was held with participants/team captains outlining course, emergency procedures and pre-race warm up rules.All participants were accounted for after the event
Signature: by signing you confirm that the information submitted is true and correct.*
Name*

First NameLast Name
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Please leave us a comment or a suggestion to help improve our services
CONTACT

Please email waivers to paddlesports@jacka-liquori.com OR

Mail to: PO Box 668, Kings Park, NY 11754

Waivers must be kept for a period of 5 years. You will be responsible for producing a signed waiver within this timeframe for any event in the event of an incident.
Should be Empty:

POST EVENT PROCESSING SUBMISSION