Tell us all about your organization!

Name of Organization *

Physical Address of Organization *

Insurance Committee Chairperson Name *

Phone Number and Email of Insurance Committee Chairperson *

Our organization property insurance carrier is: *

GuideOne Insurance

Church Mutual

Philadelphia

Cincinatti

Liberty Mutual

Other (please specify) _______________________________

必填

Our organization liability insurance carrier is: *

GuideOne Mutual

Church Mutual

Lloyd's of London

Philadelphia

Other (please specify) ________________________________

必填

Any additional information you would like us to have?