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.

NAMGBR Affiliate Chapter Event Insurance Request form

Note that all fields marked with an asterisk * are required

Club Information

Enter Your Club's name or National Club Name Here *

Enter your club's region or chapter name (if applicable) here

Enter the name of your club's contact for this event *

Please enter the club contact person's telephone number *

Event Information
Event Name *

Date/Start Date mm/dd/yyyy *

End Date if applicable mm/dd/yyyy

Type of Event *
Approx Number of Members Attending *
Will Bleachers Be Used? *

Full Postal Address of the Event Location *

Name and Full Postal Address of the Event Location Owner *

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

To Whom Should We Send the Paper Copy of the Insurance Certificate?
Name and Full Postal Address to send the Insurance Certificate to *

Who Is Submitting This Information? Who Do We Contact With Any Questions?
Info Submitted By (Name)? *

EMail Address of Submitter *

Telephone No. Of Submitter *