Additional Insured Request Form

Additional Insured Request

Your Name(Required)

Your Email Address(Required)

Event Name / Title(Required)

Event Date(s)(Required)

Name of Additional Insured Party/Organization(Required)

Name of Contact Person For Party/Organization(Required)

Contact Person Email Address(Required)

Primary Location Address(Required)

Primary Location City, State, and Zip Code(Required)

Relationship To Your Event(Required)

Property Owner/Lessor

Pool Owner

Sponsor

Co-Promoter

Does the Additional Insured require any specific wording or have any special requirements?(Required)

Yes

Special Requirements, If Applicable