Club insurance request form - USA Table Tennis - usatt 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Insured Organization' and its 'Mailing Address'. Ensure all details are accurate for proper identification.
3. Fill in the 'Date of Request' to indicate when you are submitting this form.
4. Provide your name in the 'Name of Person Completing This Form' section, followed by your phone number and fax number, if applicable.
5. In the 'Certificateholder' section, enter the name of the facility requiring insurance. Include their contact person and address as well.
6. Specify the 'Name of Event' and the corresponding date(s) needed for coverage.
7. If applicable, answer whether you have entered into any agreements that include liability clauses. If yes, attach a copy of that document.
8. If requesting Additional Insured status, provide details about their role and ensure all fields are completed before submission.

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