NOTIFICATION OF AN EVENT

Please read the instructions.

This form is to be filed when a Federation club is going to have any kind of dance or dance event at a location other than their normal hall, when no Certificate is required. If the facility requires a certificate, or need to be named as an "Additional Named Insured", use the "Request for Additional Named Insured" instead.

When you submit this form, I will generate a PDF file that you can view with the Acrobat Reader. Most people like to 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 automatically 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.

ALL INFORMATION MUST BE PROVIDED.

Club Insurance Contact Person
Association:	Oregon Federation of Square & Round Dance Clubs
Council:
	This is the person within your club who normally handles insurance issues, or who should be contacted about this event. You would be a good choice, since you are filling out the form.
Contact Name:
Contact Address:
City:
State:
Zip:
Phone:
E-mail:	Please e-mail a copy of this form to me.
Club and Event Information
Type of function:	You must choose one of these: Exhibition Dance Normal/Special Dance Group Travel Class
Club Name:
Club Address:
City:
State:
Zip:
Date of Function:
Facility being used:
Street Address of Facility:
City:
State:
Zip:
Group Travel Information (if applicable)
Date of trip:
Departure trip:
Departing From (City/State):
Destination (City/State):
One-Way Miles:
Carrier:
Additional Comments