GNCC Insurance's Site

2024 GNCC Curling Insurance Application

Grand National Curling Club 2024 Insurance Application

Name of the Member Club *

Name of the Club Contact Person *

Club Contact Phone Number *

Club Contact Email (The completed form will be sent to this address.) *

Club Tax ID Number *

Does the venue require a Certificate of Insurance *

Name of the venue? *

Physical Street Address *

Physical Address City *

Physical Address State *

Physical Address Zip Code *

Number of Members and Curlers

This section will be used to calculate the total GNCC Insurance Premium

Total number of Curling Members (per Dues Roster Sent to Julie Chanatry) Insurance is $7.50 per member. *

Total Insurance Premium

Club Authorization

I understand and agree that if the company accepts this application, coverage will begin on the date of acceptance, or on the date requested above, subject to the payment of the required premium. Premium calculation is subject to verification. It is understood that no agent is authorized to accept risks or pass on insurability. Any person who, with intent to defraud or knowingly facilitate fraud against an insurer, submits an application or files a claim with false and/or deceptive statements or calculations, may be guilty of insurance fraud.

Name and Title of applicant *

Date *

Next Steps: A .pdf file will be emailed to the address you listed on this form. Please print the .pdf file and mail it with payment to: Peter Lyons, GNCC Treasurer, 171 Taylor Street, Nashua, NH 03060 (Once payment is received Bob Hogan will email the insurance certificate to the email address on this form. Contact Bob Hogan at BobZ06@hotmail.com if you have any questions.)