Certificate of insurance request form

Complete the form below to request a copy of your health club certificate of insurance.

Policy number

Insured business name

Contact

Phone number

Insured email

Is this related to an event?

If yes, provide date

If yes, provide event type

Are you the event sponsor?

Type of interest/additional insured

If other, please specify

Interest's name

Mailing address

City

State

Zip

Contact person

Contact phone number

Contact email

Please upload any documentation you received from the requesting party. Choose file