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Certificate of Insurance Information Form

October 12, 2020 @ 8:00 am - June 30, 2021 @ 5:00 pm


Certificate of Insurance Information Form

Please provide the information necessary to complete a Certificate of Insurance for your Event.
  • Contact Information

  • Certificate Information

  • Name of Insured will be the name of your ROTARY CLUB
  • Name of the person who is requesting the Certificate of Insurance.
  • Complete the address of the Certificate Holder. A PO Box is not acceptable.
  • Please provide the name of your event.
  • Identify the name/location of where the event is being held.
  • Start and End date may be the same, but both Start and End Date must be completed.
    Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
    Start and End date may be the same, but both Start and End Date must be completed.
  • :
  • :
  • Provide a very brief description of your event.

Details

Start:
October 12 @ 8:00 am
End:
June 30, 2021 @ 5:00 pm

Organizer

Melanie Druziako
Phone:
(609) 774-3671
Email:
tricountyrotary@gmail.com
Website:
www.tricountyrotary.com

Details

Start:
October 12 @ 8:00 am
End:
June 30, 2021 @ 5:00 pm

Organizer

Melanie Druziako
Phone:
(609) 774-3671
Email:
tricountyrotary@gmail.com
Website:
www.tricountyrotary.com