Let's Fly Now Request Insurance Form

LFN Request Insurance Form

Complete this form to request insurance coverage for your event.

All fields marked with * are required.

Event Coordinator First Name

Event Coordinator Last Name

Address

City

State

Postal Code

Event Coordinator Phone

Event Coordinator Email

Event Date(s)

Event Start Time

Rain Date(s) (if any)

Certificate Holder Name (if Additional Insured is required)

Certificate Holder Address (If Additional Insured Is required)

Name of Event:

Let's Fly Now!

Does Certificate Holder need to be added as additional insured?

Yes

Question or Additional Information about event

If you are human, leave this field blank.