|OFSRDC||Oregon Federation of Square and Round Dance Clubs|
WHEN, WHERE, WHY & HOW IT HAPPENED
Please read the instructions.
This form is to be filed out when an accident or injury occurs that could potentially result in a claim against the insurance, whether or not you know there is a claim. Please complete this form within 48 hours of the accident. When the insurance company receives this form, they will send you a claim form.
When you submit this form, I will generate a PDF file that you can view with the Acrobat Reader. You should look this form over before it gets submitted to the insurance chairman. The "Preview" button will do that: it shows you a copy of the form, WITHOUT sending it. When you are finally happy with the form, use the "Submit" button instead.
When you click "Submit", a copy will be sent by email to the Federation insurance chairman. If you check the box below, a copy will be e-mailed to you as well.