Application Instructions:
2008 Insurance
1.
Please
be sure to include all information requested below. This information is
required by USDA in order to process applications.
The “Contact
person” and “Mailing address” is where the actual certificate of insurance
will be mailed, as well as, the person to be contacted for information, if
needed. Please list telephone number
with area code.
The “Number
of members” is the number of dues paying members in the club, even if they
are covered through another club. Members covered through another club do not
have to pay again for insurance. On the club roster, please indicate with a
star the members that are covered through another club and the name of the club
insuring them. The names with a star
should not be added in calculating the cost.
The “Facility
being used” is the name of the place where your club dances. The complete
street address with the zip code is needed for the dance location. This is
strictly for insurance purposes not for mailing.
The “Name as
additional insured”. is the name of the property owner(s) or organization
that wants their names added to your liability insurance policy. Normally, this
differs from the name of the facility that you are using or the location of
that facility. If not requested by the owners, leave blank. The complete street
address with zip code is needed for the dance location. This is strictly for
insurance purposes not for mailing.
If you need to report a change in location later during the year use the NOTIFICATION OF EVENT form. You will be covered; however, an additional certificate of insurance will not be issued unless requested. The actual certificate is not necessary unless the facility/owners require this documentation. If this additional documentation is required, use form “Request for certificate of additional insured for special dance”. You must allow 45 days for processing.
2.
Calculate
amount owed. The cost for 2008 is $4.10 per person. There is a $45.00 minimum.
No payment is required for students or members who
are covered through another club. If a club has 1-10 members the fee would be
the minimum, $45.00 per club. If a club has 11 or more members the fee is $4.10
x number of dancing members to be insured (do not include those covered through
another club).
3.
Make
check payable to: S.C. Square & Round Dance
Federation
4.
Mail
completed form (keep instructions for your records) with three (3) club
rosters, student roster, and check to:
9422 Plowden
Mill Road
Alcolu, SC 29001
Mailing
address: ___________________________________________________________
City:
______________________________ State:
_______ Zip: ____________________
Number
of members: __________________
Date(s)
of function: ________________________________________________________
Facility
being used: ________________________________________________________
Street
address: ____________________________________________________________
City:
______________________________ State:
_______ Zip: ____________________
Name as additional insured:
__________________________________________________
Street
address: ____________________________________________________________
City:
______________________________ State:
_______ Zip: ____________________
Name as additional insured:
__________________________________________________
Street
address: ____________________________________________________________
City:
______________________________ State:
_______ Zip: ____________________
Number
of members ______x $4.10 = amount
due $______
Number
of members (1-10) = minimum fee amount due
$45.00