Certificate of Insurance Request

request for insurance certificate

Full Name*
Prefix First Last Suffix
Email*
Phone:
Type of Event:*
Unit #:
Unit Type (Troop, Crew, Team, Post):
Dates Needed:*
Please provide a brief description of the activity:*
If certificate is for use of facilities, describe:
$1 Million Coverage*
- Yes
- No
If the amount exceeds this, please contact Audrone at the Council Service Center, 520-750-0385.
Certificate Holder Name:*
Certificate Holder Address:*
Additional Comments: