Marine Corps League, Etal (MCL) Marine Corps League, Etal (MCL) Special Event Questionnaire Certificate of Insurance Request Form For expedited service, fill out the form below. If you prefer to download, fill out, and fax a PDF form INSTEAD of filling out this form, click here. • Denotes required field. Date of Request* MM slash DD slash YYYY Department/Detachment* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person* First Last Email* Enter Email Confirm Email Daytime Phone NumberFax NumberDescribe Event*(Meeting, Convention, Seminar, Booth, Recepton, Picnic, etc.)Are you the sponsor? Yes No If NO, name of main sponsor First Last Date(s) of Event* Address of Event* Estimated attendance*Number of Exhibitors*Admission to be chargedExpected gross receiptsWill event be held indoors or outdoors?* Indoors Outdoors Have you conducted similar events in the past?* Yes No If YES, has there been any claims/losses? Yes No If YES, describe past claims/lossesDescribe security to be provided*Describe first aid to be provided*Will there be amusement rides or fireworks?* Yes No Describe refreshments planned*Are refreshments complimentary or purchased by guests?* Complimentary Purchased by guests Not Applicable How will refreshments be provided (caterer)?*Describe any cooking to be done*Does another party need a Certificate of Insurance other than what you already have?* Yes No Name* First Last Attention Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberFax NumberDoes the other party require "ADDITIONAL INSURED" wording? Yes No If YES, describe their interest(landlord, owner of premises, lessor, event sponsor, etc.)Have you agreed to "HOLD HARMLESS" the other party?If YES, please forward a copy of your contract, permit, or agreement. Yes No If a contract, permit or agreement has been signed, please attach a copy for review.Max. file size: 128 MB.By clicking the "I Accept" checkbox, you are signing this Questionnaire electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Questionnaire.* I Accept CommentsThis field is for validation purposes and should be left unchanged.
