No Obligation Professional/General Liability Quote for Instructors & Trainers
Complete this online form TODAY for an immediate quote!
(click here for a printable version)

All required fields in this form are indicated with a red asterisk: *

*First Name:

*Last Name:

Mailing Address:

*Street:

*City:

*State: *Zip Code:

*Phone:

Fax:

*Email:

When is the best time to reach you?

*Association Membership: Yes No
If Yes, please indicate which one:

If Yes, please mark all that apply:

American Morgan Horse Assn.
United States Dressage Federation
United States Team Roping Conference

Appaloosa Horse Club
United States Eventing Assn.

Arabian Horse Assn.
United States Polo Assn.

American Riding Instructors Assn………….(Are you certified by ARIA?

Yes No)

Certificate Horsemans Assn………………...(Are you certified by CHA?

Yes No)

United States Equestrian Federation (or an affiliate, please list)

Other (please list)

*Activities you are involved in:

Judge
Group Instructor
Course Designer
Clinician
Trainer

Therapeutic (addl. info. will be required)
Steward
Show Official/Mgr
Technical Delegate
Prof. Rider/Driver

*Average per month the number of students and/or horses you instruct:

*Gross Annual Receipts for activities listed above:

*Are you currently involved in boarding/breeding horses that you are NOT training? Yes No

*Do you currently have a primary farm/ranch policy? Yes No

*Do you currently have a policy that covers any of the above equine related exposures? Yes No

*Do you have any assistants or partners? Yes No
If Yes, how many and please explain relationship?:

Are you involved in any of the following,

Pony Rides
Sleigh Rides
Trail Rides

Day Camps
Horse Sales
Other

*When would you like for coverage to begin? (please note that only future dates can be considered)

Please add my name to your mailing list.

* Please tell us how you heard about us.

Other/Please Specify:


 All coverages are subject to policy limits, conditions and exclusions.