Rodeo Contestant Accident Coverage
App1.02a
Type of Policy..........................
Rodeo Contestant
Name of Association.................
Street Address........................
City, State Zip.........................
,
Name of Event...........................
Name of Rodeo Arena................
Street Address.......................
City, State Zip........................
,
Approximate Number
..................
of Contestants.......................
Number of Entries....................
Events Conducted....................
(i.e. Calf Roping, Bullriding, etc...)
.......
Performance Dates..................
From:
/
/20
To:
/
/20
Total Performances:
Sanctioning Organization (if any).
Limits.......................................
Accidental Death & Dismemberment: $
Excess Medical: $
Deductible: $
Premium: $_____________________ (we will call you with a quotation)
Name of Contact Person............
Social Security # or Tax ID#.......
Phone Number..........................
Fax Number..............................
E-Mail Address..........................
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