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 *

Facility Address

City

State/Province

Zip/Postal

Country

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

City

State/Province

Zip/Postal

Country

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

Drop a file here or click to upload Choose File

Maximum upload size: 516MB

This will be attached to the ODS Website Calendar.

Fees *

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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 *

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