Chapter Event Liability Insurance Form

Many chapters hold and sponsor events held at venues, such as hotels, hospitals, community centers and conference centers. These types of locations often require proof of liability insurance coverage. All chapters are covered under the AACN master policy. When proof of coverage is required, chapters need to contact the National office and request a certificate of insurance to be sent to the facility. This service is provided to the chapters free of charge.

Chapter event liability insurance is designed to cover both community educational events, as well as traditional chapter educational offerings. The liability insurance provides $2,000,000 in general aggregate coverage, $1,000,000 in personal injury, $50,000 in fire damage and $5,000 in medical expenses.

The procedure for requesting an insurance certificate is to complete the online Event Liability Insurance Form below. The certificate of insurance will then be mailed or emailed to the necessary people, within 10 business days.

If you have any questions, please contact the Chapter Department, at 800-394-5995, ext. 365 or by e-mail at

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Chapter Information

Chapter Name : *
please spell out the full chapter name
Contact Person: *
Address: *
City: *
State: *
Zip Code: *
Contact Phone Number : *
Contact Fax Number:
Contact Email Address: *
Send Certificate Copy to Contact Person Via: *
If US Mail is selected, list mailing address below.
Mail Certificate to:

Event Information

Name of chapter event: *
Date(s) of event : *
mm/dd/yyyy - Separate multiple dates by commas.
Address of event: *
Name and address to whom proof of liability insurance should be provided: *
Event Coordinator(s): *
Co-Sponsor (If no Co-Sponsor, enter none) :
Service(s) that will be provided at this event? :
The Event Coordinator/Co-Sponsor needs to be additionally insured under this policy: *
Date Completed: *
Completed by: *
Your Email: *




revised 2/13

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