WALLEYES UNLIMITED OF MONTANA EVENT LIABILITY INSURANCE REMITTANCE FORM

Please fill out the online form and mail your check to:

Walleyes Unlimited of Montana
C/O Ben Davis
PO BOX 20918
Billings MT 59104

Your insurance coverage certificate will be mailed to you before your event(s).

If you prefer to use a paper printed application, please download here –> Liability Insurance Form

Chapter or Tournament Name: *

Contact Email *

Date: *

Address: *

City, State & Zip: *

Submitting Officers’ Printed Name: *

First

Last

Phone Number: (no dashes or spaces please) *

"Banquet Event" –> Please provide the following information: Date – Estimated Attendance and Location.

"Kids Day Event" –> Please provide the following information: Date – Estimated Attendance and Location. If you have more than one event, please add all of them here.

"Tournament Event" –> Please provide the following information: Date – Estimated Attendance and Location. If you have more than one event, please add all of them here.

**Please use this field if an additional certificate is being requested or required for a facility with their name on it or for tournaments, if the BOR is requiring they are listed as additional insured.

Please include check # and total amount paid to State:

Submit

*If you need a rider for an event or any other insurance coverage questions, please call Julie DeMarsico at: 406-899-8154 or email Walleyesinsurance@outlook.com

**If the facility where you hold your banquet has liability coverage of its own, please enclose proof of said coverage and the banquet fee may be waived.

****This form needs to be filled out with all of the events for the year that you anticipate having for the chapter with a charge for the 3 main events – Banquets, 1 Tournament, Kid’s Day $300/day per these events. So, if the tournament runs for two days, it would be $600 paid for the tournament cost. Please mail the check with this form to the treasurer’s address listed at the top of this form, and email or fax a copy of the events request form to Julie DeMarsico at:  fax 406-899-8154