Certificate of Insurance Request Form

Complete the Certificate of Insurance Request Form.

Send to: Attention Wendy Ann Henry

Email: wendyann.henry@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:

Wendy Ann Henry | Account Manager
Affinity Nonprofits 
2001 K Street NW Suite 625 North, 6th Floor
Washington DC, 20036

Email:        wendyann.henry@affinitynonprofits.com 
Website:    affinitynonprofits.com


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