OWCA ANNUAL CLUB CERTIFICATE OF INSURANCE REQUEST FORM

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

OWCA Annual Club Certificate of Insurance Request Form

"*" indicates required fields

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

Have you submitted your annual membership and insurance fees payment

Yes

Number of active members in your club

Please attach your club member list to this form (first and last names only):

Max. file size: 64 MB.

Additional Information

(supply us with anything you feel is pertinent regarding your club):

Club Insurance Fee

Price:

Credit Card

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