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North American Rowing Association

Certificate of Insurance Request Form

PLEASE NOTE: A Certificate Holder can only be considered an Additional Insured if a Written Contract exists between them and you.
Insured Information:
Name of Club: *
Insured Contact Person: *
Phone: *
Email: *
Name and address of Additional Insured(s) Requesting Certificate:
*
Relationship of Additional Insured(s) to the Club or Event: *
If other, please specify Relationship type: *
In the space provided please provide Specific Details of What your Relationship to the entity is:
*
Special instructions:

Name of Event: (If applicable)
Event Date(s): (If applicable)
Enter Verification Code:
  
All Certificates will be emailed to the Insured Contact Person Indicated above, unless otherwise indicated.