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 Association………….(Are you certified by ARIA?
Yes No)
Certified Horsemanship Association...(Are you certified by CHA?
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: 0-15 16-29 30-50 51 and over
*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. AOL Google MSN Yahoo Other Search Engine American Driving Society (Please Specify) American Morgan Horse Association (Please specify) American Riding Instructors (Please specify) Arabian Horse Association (Please specify) Association Resource Group (Please specify) At Show Exhibition (Please name the show) Certified Horse Association (Please specify) Friend/Referral Intercollegiate Horse Association (Please specify) My Horse Council (Please specify the State) United States Dressage Federation (Please specify) United States Equestrian Federation (Please specify) United States Hunter Jumper Association (Please specify) United States Polo Association (Please specify) United States Team Roping (Please specify) Other Equestrian Association/Club/Council Not Listed Here (Please Specify) Other/Please Specify: All coverages are subject to policy limits, conditions and exclusions.