IHSA Event Insurance Request Form IHSA Event Insurance Request Intercollegiate Horse Show Association Event Insurance Request Form Are you an insurance agent or broker?* Yes No For The Month Of:* Zone:* Region* Submitted By:* First Last Email* Is this an IHSA sanctioned event?* Yes No Date(s) of Show (include all dates to be covered for this event):* # of Days for this show:* Sponsoring School(s): List of Additional Insured(s).*Please note that Name and Complete Mailing Address and Interest must be provided for all Additional Insureds.Name of Additional Insured #1:* Mailing Address* Street City State / Province / Region ZIP / Postal Code Their Interest:*(Check all that apply) Landowner Facility Owner Horse Provider Name of Additional Insured #2: Mailing Address Street City State / Province / Region ZIP / Postal Code Their Interest:(Check all that apply) Landowner Facility Owner Horse Provider Notes Δ