WAI REQUEST FOR CERTIFICATE OF INSURANCE
This form is only required if the entity requesting Proof of Coverage is asking to be named as Additional Insured.
Email address *
Today's Date *
MM
/
DD
/
YYYY
Chapter Name *
Your answer
Chapter Contact (Person) *
Your answer
Contact Person Email *
Your answer
Contact Person Phone Number *
Your answer
Event Name *
Your answer
Date of Event *
MM
/
DD
/
YYYY
Event Location and Address *
Your answer
Is the entity requesting Proof of Coverage requesting to be named as Additional Insured? *
Next
Never submit passwords through Google Forms.
This form was created inside of Women in Aviation International. Report Abuse - Terms of Service