Event Insurance Request

The North American MGB Register’s insurance program enables affiliated clubs to cover their qualifying events with up to US$2 million of liability insurance. Please complete the request form below to have an insurance certificate issued for your event.

NOTE: All requests for event insurance coverage MUST go thru the Vice Chairman!

NAMGBR Affiliate Chapter Event Insurance Request form

Note that all fields marked with an asterisk * are required

Club Information

Name of Requesting Affiliated Club *

Club Contact Person for this Event *

Club Contact Phone *

Club Contact email *

Date/Start Date mm/dd/yyyy *

End Date if applicable mm/dd/yyyy

Approximate Number of People that will Attend *
Type of Event *
Will Bleachers Be Used? *

Owner of Premises where Event will be held*

Name/Address Certificate to be mailed to *

Special Instructions or Attachments

If you need to attach a copy of a contract, or other event details, please select your file here. File size is max 2Mb and file types can only be: PDF, DOC, DOCX, RTF, JPG, PNG or TIFF

Need to attach more than one file? Select the second file here. Same options/restrictions apply

Please provide any special instructions or additional information here. If you Selected Event Type "Other" provide details here