Trainer/Instructor Quick Quote New Trainer/Instructor Quote Request Are you an insurance agent or broker?* Yes No Name* First Last Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Website Address* If not applicable type "none"Association Membership* Yes No If so please check all that apply (CHA) Certified Horsemanship Association (PATH) Professional Association of Therapeutic Horsemanship Other None If "Other" please describe Activities you are involved in* Judge Group Instructor Course Designer Clinician Trainer Steward Show Official Polo Groom Technical Delegate Professional Rider/Driver Therapeutic (see the next two questions) If you selected "Clinician" in the list above, how many Clinic Days do you offer per year? If you are an EAAT instructor, what program are you certified with? *If you are certified please indicate length of certification below.How many years have you been certified? Average per month the number of students and/or horses you instruct*0-1516-2930-4950+Gross Annual Receipts for activities listed above* NOTE: Gross Annual Receipts = the total amount of money received before subtracting taxes, costs and expenses.Are you responsible for 24 hour care of non-owned horses? (either by boarding contracts or horses in training)* Yes No If "Yes" to question above please indicate the Gross Annual Receipts and Average Number of Horses below.Gross Annual ReceiptsUp to $100,000$100,001 - $150,000$150,001 - $200,000$200,001 - $250,000$250,001 +Average Number of Horses1 - 15 Horses16 - 25 Horses26 - 35 Horses36 - 45 Horses46 - 55 Horses56+ HorsesDo you currently have a primary farm/ranch policy? Yes No Do you currently have a policy that covers any of the above equine related exposures? Yes No Do you have assistants or partners?* Yes No If "Yes" for assistants or partners, how many? Do you use volunteers or working students?* Yes No NOTE: This includes anybody offering to take part in equine activities without remuneration. These individuals will NOT be giving lessons or advice as an expert or representative or acting as a person of authority (including any on ground instruction).If "Yes" on volunteers, how many on average per month?1 - 6 Volunteers7 - 12 Volunteers13 - 18 Volunteers19 - 24 Volunteers25 - 50 Volunteers50+ VolunteersDo you offer any of the following additional activities?NOTE: A reoccurring student is someone you have frequent contact with and have excellent working knowledge of their horsemanship.Pony/Horse Rides Yes No Includes traveling or at one location where horses or ponies are led in a round pen or hand held for special events, birthday parties, etc. Nor for reoccurring students (see definition above)Gross Annual Receipts for Pony/Horse Rides Number of Days for Pony Horse Rides Day Camps Yes No One day or multi day event offering equine activities or anything advertised as a "Camp". (For all events other than reoccurring 1 - 2 hour lessons and no overnight exposure.)Gross Annual Receipts for Day Camps Number of Days for Day Camps Horse Drawn Vehicle Rides Yes No Gross Annual Receipts for Horse Drawn Vehicle Rides Number of Days for Horse Drawn Vehicle Rides Fundraisers Yes No Please describe any fundraising events.Sleigh Rides Yes No Horse Sales Yes No Providing advice on purchase of a horse that is owned by you or not owned by you, whether in your care, custody, control or not. Also, if you receive any kind of remuneration or act as an agent/broker or if you have involvement in a horse auction.If you answered Yes on Horse Sales, what are your Gross Annual Receipts for Horse Sales? Guided Trail Rides Yes No This includes trail rides led by you, a wrangler or any other party for recreational riding that is open to the general public for any length of time including hourly, long distance and/or multi-day trips.Number of days for Guided Trail Rides Trail Rides as part of a lesson Yes No This is for reoccurring students (see definition above) that have trail rides as a part of their regular lesson.Please list any additional activies not listed above.How did you hear about us*Internet Search (Please specify words searched below)American Driving SocietyAmerican Morgan Horse AssociationAmerican Riding InstructorsAmerican Vaulting AssociationArabian Horse AssociationAssociation Resource GroupCertified Horse AssociationFriend/Stable/Referral (Tell us who to thank below)Intercollegiate Horse AssociationLinkedInMy Horse Council (Please specify the state below)Tradeshow (Please specify below)United States Dressage FederationUnited States Equestrian FederationUnited States Hunter Jumper AssociationUnited States Polo AssociationUnited States Team RopingOther Equestrian Association/Club/Council Not Listed Here (Please specify below)Other/Please Specify Details Please list any additional commentsNameThis field is for validation purposes and should be left unchanged. 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