OWCA SPECIAL EVENT CERTIFICATE OF INSURANCE (COI) REQUEST FORM

For questions, please contact Lynn Burnett, Director of Insurance at: insurance@ontariowoodcarvers.com or 519-994-2280

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Name of Club*

Name of Club member requesting COI*

First Last

Email*

Phone*

Club Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Club President's Name

Phone

Event Name

Purpose of Event

Event Location

Event Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date*

Finish Date*

Additional Information

(ie. will carving instruction take place. Will safety instruction be provided. Will personal protective equipment be provided, etc):

Our Address