IHSA Event Insurance Request | Equisure

All fields marked (*) are required.

For The Month Of: *

Zone *

Region *

If Western show indicate area

Submitted By:

First *

Last *

Email *

Is this an IHSA sanctioned event? *

Yes

No

Date(s) of Show (include all dates to be covered for this event): *

Sponsoring School(s):

List of Additional Insured(s)

*Please note that Name and Complete Mailing Address and Interest must be provided for all Additional Insureds.

Name of Additional Insured #1:

Mailling Address

Street Address

City

Zip

State

Their Interest:

(Check all that apply)

Landowner

Facility Owner

Horse Provider

Name of Additional Insured #2:

Mailling Address

Street Address

City

Zip

State

Their Interest:

(Check all that apply)

Landowner

Facility Owner

Horse Provider

Notes