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NICA Sanctioned Event Insurance Request
Form request for NICA Liability Insurance for NICA Sanctioned Events: INCLUDES - Races, Leaders Summits, Fundraisers, Wilderness First Aid Training, Auctions, Pledge Rides, Fundraisers, Coaches Training, Racer Camps. Please submit insurance requests at least TEN DAYS PRIOR to your event. If lead time is less then ten days please email julia@nationalmtb.org with your event date, after submitting this form.
League Name *
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Requestors Name *
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E-mail *
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Event Date *
Enter the first date of your event in THIS format (for priority sorting purposes) XX/XX/XXXX
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Event Date(s) - (YES, we're asking for the date again, for coverage purposes) *
If Multiple Day Event, Please Include Corresponding Date to Each Event
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Event Name *
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Event Website: *
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Type of Event(s) *
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Event Location *
Street Address, State, Zip Code
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Estimated Number of Participants (Include Volunteers) *
If Multiple Day Event, Please Include Corresponding Estimate of Participants to Date / Event
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Certificate Requests
Do any other entities need to be additionally insured for the event? Please provide detailed information in the space below. Include the ADDRESS and contact information of any entity that needs to be additionally insured:
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Anything Else We Need to Know?
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