Chapter Request for Certificate of Insurance

The NKBA’s insurance policy provides liability insurance coverage for our Chapters for activities within the normal course of Chapter operations. You may be requested by a venue or show promoter to submit evidence of insurance prior to the Chapter participating in or conducting an event. NKBA will provide you with a copy of the Certificate upon request.

In order for our insurance company to properly prepare the Certificate, we require that you provide us with certain information.

Furnish this information at least two (2) weeks prior to the function or event.

Your Name*
First Last
Your Email*
Chapter*
Name/Type of Function or Event*
Date of Event*
MM slash DD slash YYYY
Location of Event*
Is the entity requiring the Insurance Certificate different from the chapter?*
- Yes
- No
Exact name of entity requesting Insurance Certificate:*
Exact address of entity requesting Insurance Certificate:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Copy of Contract or Agreement (if Applicable)
Max. file size: 256 MB.