ALL REQUESTS SHOULD BE SUBMITTED
 AT LEAST ONE MONTH  BEFORE THE EVENT DATE  

The following information must be provided:

Name of Chapter.
Chapter Contact Name, mailing address, Phone number and email address.
Name of event and date(s).
What the the group function will actually be (contest, display, make n take, seminar, etc )
Name of the facility, physical address of the facility.
Name of any additional insured for the facility (i.e. owner of a mall, or name of city owning a facility )  

This information can be sent via email to: manager@ipmsusa.org

Or transmitted via fax to 330-478-3882

Or by Telephone to: 330-477-6622

Insurance requests may also be submitted in writing via U.S. Mail to:

IPMS/USA Office Manager
PO Box 2475
N. Canton, OH
44720-0475

Your timely submission of this Event information will ensure that you receive your insurance certificate in time for your Event!

8/10/05