Please add each of your race events to be covered (additional activities can be added in the field(s) below).

Event Name

Type (or distance) of Event

(5K, 10K, Half Marathon, etc.)

Event Location

At minimum, you must include a street name, city, state and zip code.

Event Organizer's Name (entity to be covered)

Email

Note: If you need to change the dates below at any time, please contact us; you may not be covered otherwise

Estimated Total Number of Participants

Do not include your volunteers or staff members - these individuals are covered under the group accident and general liability policies

Add Additional Event(s) Below

Please include the following for each additional event needing coverage - Event Name, Event Location, Event Organizer (individual or entity to be covered), First Day of Event (include set up dates), Last Day of Event (include dismantlement dates), Estimated Total Number of Participants (do not include your volunteers or staff members - these individuals are covered under the group accident and general liability policies.

Additional Activities to be covered

Please enter additional activities you would like to cover. If any of these activities are scheduled outside of the event dates listed above, please adjust the coverage dates below.

Frequency, duration and estimated number of participants (do not include volunteers or staff members - these individuals are covered under the group accident and general liability policies

Coverage Period

The coverage period should include the dates of all of your races and additional activities

Underwriting Information

If yes, please provide an explanation below:

Optional Coverages

Additional Insureds

Please add any additional insureds that are required below

American Trail Running Association (need address)

American Trail Running Association is automatically added as an Additional Insured to all policies

Add Additional Insureds below

To add Additional Insureds, please include the following for EACH Additional Insureds - Legal Name, First Name, Last Name, Address, City, State, Zip Code, Email, Relationship to the Insured (Venue, Municipality, Contractor, etc.) and any required certificate verbiage.

Please list each Additional Insured that requires the Primary and Non-Contributory Endorsement below.

Do you have: (a) Any further material facts to disclose (material facts which might influence the acceptance or assessment of the application); OR (b) Any special non-standard request for coverage which you wish underwriters to consider? Please enter any material facts or special coverage requests below: *

Please provide details or type "NO" below

PLEASE READ AND SIGN (By typing your name) BELOW:

Title

Please note: this event insurance application is subject to full underwriting. The decision to provide a quote or not is, in part, determined by the answers you have provided in the above application. Should a policy be issued, it will include certain exclusions and limitations. It is the applicant/insured's responsibility to read and understand the terms in any policy that is issued and bound. Not all insurance products are available in all states. Please contact the Nicholas Hill Group, Inc. by emailing [email protected] with any product questions. All insurance products are provided by licensed representatives.

Agent Signature: Ryan E. Hill

Agency: Nicholas Hill Group, Inc.

T.R.I.P. Protectevent Liability & Participant Accident insurance application

T.R.I.P. Protect
event Liability & Participant Accident insurance application