Event Planning Template
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1Name of Event
Name of Club
INSURANCE QUESTIONS:
Details
Organizer
Organization
Organization's Email
Organization's Address
Organizer's Phone
Type of Certificate Requested
Certificate for Club or Team Races, Events, Series, Rides or other Activties
Is this certificate for a single event or a series of several events?
Dates?
Name of the Single Event or Series of Events
Name of the Event Organizer or Series Coordinator. Must be a Cycling BC license holder.
E-mail address of Organizer or Series Coordinator.
Phone# of Organizer or Series Coordinator.
Cell Phone# of Organizer or Series Coordinator.
Estimate the number of members (club members or license holders) that will attend the event.
Estimate the number of non-members (people who need a single event license) that will attend.
EVENT DETAILS
Event Ages & Activities
List the age categories of participants expected to attend the event. Select all that apply.
Youth (ages 4 to 16)
Junior (ages 17 and 18)
Senior (ages 19 - 29)
Master (ages 30 to 80)
EVENT DETAILS
Other Details
Describe any non-cycling related activities held at the event.
Provide estimated spectator attendance at the event.
Will you be renting tents, lighting systems, or temporary stages or bleachers for the event?
Will liquor be served at the event? If yes, forward a copy of your liquor permit to Cycling BC.
In case liquor is served, confirm that the bartender is "Serving it Right" Certified.
Has the event or series been held in the past?
Has the event or series suffered an insurance loss in the past 5 years?
Are road closures required for the event? If yes, forward a map of all closures to Cycling BC.
Do any of the additional insured parties required the phrase "Cross Liability" on the certificate?
Do any of the additional insured parties require the certificate printed on a special form?
Does the name on permit matches the name of club or org'n requesting H0111?
Ad. Insureds: Name, Address, Function (Gov't, Municipality, Sponsor, or Landowner)
In the section below, list the following information for all additional insureds.
Additional Insured #1
Additional Insured #2
Additional Insured #3
Additional Insured #4
Additional Insured #5
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Parent category: Life