Certificate of Liability Insurance Request Form

Today's Date 0/0

Organization Where Meeting/Activity Will Be Held (i.e. school, community center) 0/0

Address Where Meeting/Activity Will Be Held 0/0

Phone Number Where Meeting/Activity Will Be Held 0/0

Point of Contact for Organization 0/0

Point of contact Email 0/0

Special Notes to be Included on the Certificate (rare) 0/0

Reason for Request 0/0

Name of GSNMT Member Requesting Certificate 0/0

Email Address of GSNMT member Requesting Certificate 0/0

Service Unit Name or Number 0/0

Troop Number 0/0