The Wright Insurance Agency

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Social Club Coordinators

Name of Business:
Contact Name :
Address:
City:
State & Zip:
Phone Number:
Fax Number:
E-mail:
Description of the Event: List of ALL Performers
Name of the Event:
Date of the Event:
Attendance & Venue Capacity:
Description of Security Measures:
Price for Admission:
Please define the components of your event:
Concert:	Yes No
Trade Show:	Yes No
Parade:	Yes No
Sport Event:	Yes No
Film / TV:	Yes No
Special Event:	Yes No
Will food or concessions be sold / served at this event?	Yes No
Will alcoholic beverages be sold / served at this event?	Yes No
Location Information:
Location of Event:
Address of Event:
City:
State & Zip:
Additional Quotes Needed:
Weather Cancellation Non-Apperance


*** The preliminary rate quotes generated by this program are estimates based upon the information you provided and is not a contract, binder, or agreement to extend insurance coverage

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