National Slo-Pitch Liquor Liability Application
NOTE: YOU must be an NSA Sanctioned member in order to apply. If you are not a member the application is not valid.
Applicant First & Last Name *
Your answer
Applicant address Including Postal Code *
Your answer
email address of applicant *
Your Certificate will be sent to this email address
Your answer
Contact Phone # of applicant *
If we have any issues with your certificate we may need to contact you
Your answer
Is this a Funtastic Event? *
Please note, Funtastic events require specific underwriting considerations and must contact our office directly.
Name of Event *
ie. Year end banquet
Your answer
Name of Event Venue *
ie. Park city community centre
Your answer
Address of Event Venue including Postal code *
Your answer
Effective Date of Coverage *
MM
/
DD
/
YYYY
Time
:
Expiry Date of Coverage *
MM
/
DD
/
YYYY
Time
:
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