Certificate of Insurance Request Form

Complete the Certificate of Insurance Request Form.

Send to: Attention Michelle Evans

Fax: 847.953.2672

Email: michelle.evans@affinitynonprofits.com

Instructions for completing the Certificate of Insurance request form:

Name of Insured – "Beta Alpha Psi"

Chapter Name - “Enter your chapter name and number here”

Address – "Enter your school/chapter address here"

Describe Event – You must include a sentence describing the event. Example: “Multi-chapter Softball Tournament”

Certificate Holder – “Enter name and contact information for person(s) requesting the certificate of insurance.”

Representative Contact Information:

Michelle Evans | Account Manager
Aon Association Services a Division of Affinity Insurance Services, Inc.
1120 20th Street, NW, 6th Floor
Washington DC, 20036

Email:        michelle.evans@affinitynonprofits.com 
Website:    www.nonprofitinsurancesolutions.com