UTSU Club Insurance Certificate Request 2022-2023

Club Information

Club Name*

Primary Contact*

First Name

Last Name

Phone Number*

Club Email*

Date and Time of Event*

Venue Name and Address*

Address Line 1

Address Line 2

City

Province

Postal Code

Description of Event*

How many people will be attending (total)?*

Will the event take place indoors?*

Will the event take place outdoors?*

Will there be security?*

How many security guards?

Will alcohol be served?*

Will you be providing transportation to the venue?*

Type of certificate needed*

Proof of Insurance only Insurance + Venue

Certificate Holder Name

Certificate Holder Address

Event Contract*

No File Chosen

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Is there an emergency plan?*