Are you an insurance agent or broker? *

Yes

No

City *

Zip *

State *

Contact's Mailing Address

Applicant First Name *

Applicant Last Name *

City *

Zip *

State *

Phone

Email *

Actual Date the Event Begins *

Actual Date the Event Ends *

Is this a sanctioned event? *

Yes

No

Further Description of Event

Select all that apply

Gymkhana

Horse Show

Roping

Other

Do you require coverage for set-up and take-down days? *

Yes

No

If "Yes", what is the first day of set-up?

What is last day of take-down?

Which Limit of Liability do you require? *

$500,000

$1,000,000

$2,000,000

Does the event require a signed release or waiver from ALL competitors? *

Yes

No

Has this event incurred any liability claims within the last 5 years? *

Yes

No

Does the show management, officials, or judges use golf carts or any other off road vehicles that are leased by the show? *

Yes

No

How did you hear about us? *

Please select below Internet Search (Please specify words searched below) American Kennel Club Friend/Referral LinkedIn Trade Show (Please specify below) United Kennel Club Other Club or Organization (Please specify below)