Insurance Form

Use the following form to obtain liability insurance coverage for shows and trials held in the name of the ABTC. ABTC insurance is only for liability coverage (no worker\'s comp) and covers both the hosting group\'s ABTC members and any other non-ABTC members assisting them. ABTC show events will be covered by the Club\'s liability insurance policy ONLY if the following procedures are followed: Requests must be completed at least 10 days or more in advance of the date of your event(s). If there is more than one facilities owner/lessor (like at the national or regional specialties), request all certificates at the same time, one for each owner/lessor. Complete and submit the on-line form below.

Enter the date by which you need the certificate (*)

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Enter Facility Owners Name (*)

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Enter the name of the local club or chairperson (*)

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Enter the Name of the event (This must read \"ABTC .......\" like \"ABTC Obedience Trial\" or \"ABTC Conformation & Agility Trials.\" Your clubs\' name must not appear in the event\'s name, nor may it appear in any premium list or advertising. (No PO boxes) (*)

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Event Start Date (*)

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Event Stop Date (*)

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Enter the address of the event (street, City, State) (*)

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The primary name and address where a certificate will be sent. Certificates are normally sent to the facility / owner of the property. Address should include zip code. Include fax number(s) when available. (*)

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The secondary name and address where a certificate will be sent. Address should include zip code. Include fax number(s) when available.

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The names of additionally insured

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Requesters Name (*)

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Email address of requester (*)

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Comments

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