Request For Insurance Request For Insurance Name of Event * Type of Event * ODS League Show USEF/USDF Licensed Show Practice or Schooling Show Clinic or Workshop with Horses Open to Public Clinic or Workshop with Horses Restricted to Members Only OtherOther Name of Chapter or Committee Hosting Event: Start Date of Event: * If this is a single day event, just fill this date out and leave the "End Date of Event" below field blank End Date of Event: If applicable, Opening Date or First Day Registrations will be Accepted If applicable, Closing Date or Registration Deadline Name and Rating of Judge or Clinician (list all, please) * List like this: Firstname Last Name (rating) Name of Organizer * First Name of Organizer Last: Last Primary Phone Number for Organizer (in case office has questions) Note: while both should be, either manager or secretary must be an ODS member Organizer's Email: Facility Name / Location of Event: * Does this facility want to be named as "Additional Insured"? Note: this is the only way to receive a written certificate. * Yes No Has this facility alreday received an insurance certificate from ODS this calendar year? * Yes No I am not sure Legal Name of Property Owner * Facility Address * Email address for Facility (sometimes we are able to e-mail certificates) ONLY IF DIFFERENT than the Facility Address above, address to mail insurance certificate Is this show approved by USDF? * Yes No If you answered yes, Competition or Educational Event ID: Does this event require insurance for USEF? * Yes No If you answered yes, Competition License Number: Does this event require insurance for any other entities? * Yes No Additional Party for Insurance / Their Interest in this Event Details About the Event: * This is what will be published about your Event on the ODS Website Master Calendar. Include any special approvals, qualifiers, etc., details about entry (i.e. what form to use), etc. You may upload a flier for the event here This will be attached to the ODS Website Calendar. Fees * General Show Insurance (for ODS or Chapter, for up to 100 participants), $51 per day General Clinic Insurance (for ODS or Chapter, for up to 100 participants), $43 per day ODS Member Only Clinic Insurance Show Insurance (for ODS or Chapter, for up to 100 participants) Additional Insured (per certificate), paid once per calendar year, $25 Rush Fee ($20 if application accepted and event is within 4 weeks, $40 if event is within 2 weeks) Mandatory $10 Processing Fee Paragraph Organizer has read the ODS Policies and Procedures Manual and/or reviewed the ODS Website and understands the rules and conditions of ODS Show Approval. Organizer is responsible for proper post-event paperwork to be turned into the ODS Office. If an ODS event (chapter/committee/ODS Board), this includes turning in any required tax forms for any independent contractors paid and financial reports. Signature * Use your mouse or finger to draw your signature above Submit
