ALPHA PHI ALPHA FRATERNITY, INC. ®
2313 SAINT PAUL ST., BALTIMORE, MD 21218-5211 SPECIAL EVENT CHECKLIST
AUTHORIZING OFFICERS *President:
Signature:
Date:
Treasurer:
Signature:
Date:
Vice President:
Signature:
Date:
Risk Management Officer:
Signature:
Date:
*Event Chairman
Signature:
Date:
*Advisor (College Chapters):
Signature:
Date:
* Required Signatures – Checklist will be returned and not processed if all required signatures are not listed. DISCLAIMER This questionnaire is being used to assist the chapter in having a safe event. DID YOU REMEMBER TO? Get all required signatures Include all additional insured to be included on the policy (if applicable) Indicate how the certificate of insurance should be returned to the chairperson Present a complete and professional form Include copy of flier/promotional materials Please return this Special Event Checklist to the Corporate Headquarters (insurance@apa1906.net) no later than three weeks (21 days) prior to the event. Forms received the week of the event will NOT be processed. Failure to submit this form within the appropriate time frame will result in the certificate not being processed in time for the event and will be subject to a late processing fee. Waiver forms should be signed by the participants involved in athletic events, however the Chapter keeps the waiver forms for their records and do not have to forward them with the Checklist. Please review the Insurance Manual on at http://apa1906.net for additional questions.
Phone: 410.554.0040 Fax: 410.554.0054 Email: insurance@apa1906.net
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Documented updated 10.06.2010