Fillable Do you have insurance now? Yes No Limits? (Risk Placement Services, Inc.)

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Do you have insurance now? Yes No Limits? (Risk Placement Services, Inc.)

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BALLOON CLUB LIABILITY APPLICATION
Name and Address of Club:
Type: Non Profit, Profit, Corp. Informal? Year Founded: Website: www:
Proposed Effective Date:
Do you have insurance now? Yes No Limits? Carrier? Premium?
Contact Person: Name, Phone, E-mail
Do you have a Physical Location? If yes, please list:
Total Number of Members: Active Members:
Frequency of Member Meetings?
Location:
Average Attendance?
Number of Informal Balloon
Meets/Rallies?
Number of Participants?
Number of Formal Balloon Meets/Rallies?
Number of Participants?
Number of Competition Events?
Number of Participants?
Safety Seminars? Include Location and Number of Attendees.
Other Activities. Describe:
Publications/Newsletters? Frequency and Distribution.
Sell Anything? Tees, hats, etc. Describe.
Does Club Own a Balloon? If Yes, Insurance Carrier, Limits.
Any Additional Insured or Certificate Requirements?
Any Employees? Describe.
Signature:
Title:
Date:
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Do you have insurance now Yes No Limits (Risk Placement Services, Inc.)

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Completed 30 July 2020

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