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*indicates required fields *Eligible Event (Must specify) Anniversary Receptions Archery Tournament Auctions Automobile Shows Band Competitions (No Rock) Baseball Camps / Programs / Tournaments Basketball Camps / Exhibitions Bazaars Beauty Pageants Bikethons Billiard or Pool Tournaments Bingo Games Boat Shows (no water exposure) Booths Bowling Tournaments Boxing Events Choral Competitions Circuses Club - Athletic Sports Concerts - Symphonic & Acapella ONLY Concession Stands Conventions - Fraternal / Professional / Trade / Veterans Craft Fairs and Shows Dances (NO heavy rock,rave,punk,rap) Demonstrations in Store Dog or Cat Shows Dog Races Exhibitions - Educational or Trade (inside or outside) Fairs (no fireworks) Festivals and Celebrations Fishing Tournaments Flea Markets Football Camps / Games Golf Tournaments Gymnastic Tournaments Haunted Houses (with no mechanical devices) Hay Rides Home or Garden Shows Home or Garden Tours Horse Racing or Shows Ice Sailing Iditarod Lectures or Speaking Engagements Marching Competitions Meetings or Seminars Markets Model Airplane Contests Model Homes (temporary exhibits) Musicals Music Festivals or Competitions Outings Parades Picnics Pig Roasts Recitals Refreshment Stands Religious Meetings Runathons Shooting Competition - NRA approved ranges Skating Events Soap Box Derbies Soccer Games or Tournaments Social Gatherings and Meetings Softball Programs or Tournaments Sports Programs - Youth Surfing Swimming Tournaments Track Meets Tractor Pulls Turkey Shoots Vacations Walkathons Weddings/Receptions Wind Surfing Wrestling Camps or Events Yard Sales Youth Reception Programs Zoos Other *Insured *Name of Applicant *E-mail *Street address *City State *Zip Code Home Phone Work Phone FAX   *Address *City State *Zip Code Date of Event Coverage dates req'd. Time of event  FROM      TO  *Estimated attendance per day *Total estimated participants Gross receipts *Maximum capacity of location *Describe location of event       Event will be held?    indoors       outdoors    Seating will be?    reserved     general admission    Crowd control    ushers      private security    off-duty police    armed    unarmed   Crowd control (be specific) Applicant's experience in conducting events of this or similar nature Any celebrities to be present? Yes  No       If yes, who?    Will bleachers or platforms be used? Yes  No     permanent    portable    Platform or bleacher construction:    wood      steel      concrete      other   More about construction  Height in feet:   Age:   Condition:  Does event involve any hazards? (check all that apply)  fireworks    amusement rides/devices    food sales    alcoholic beverage sales       Interest of applicant?  sponsor       operator   If applicant is sponsor, does the operator have liability insurance?    Yes     No Operators insurance   Limit carried:      Name of company:   Have certificates of insurance been obtained from operator?    Yes     No Does applicant agree to hold harmless any third party?    Yes     No Is applicant held harmless by others?    Yes     No     (if answered yes, please fax copies of contracts) Loss experience from prior events of same or similar nature:   Date of loss:       Nature of loss:   Amount paid or outstanding:    Limit of liability is $1,000,000!   Is products coverage desired?  Yes     No Request for Additional Insured?    Yes     No      If yes, how many        How would you like to receive your free Special Events Program Insurance quote? U.S.Postal E-mail Fax