Club and Intramural Sports Insurance

Catastrophic Policy Application —
Intercollegiate, Club, and Intramural Sports

Complete to obtain a quotation for catastrophic insurance for your club & intramural sports programs. Provides medical limits up to $5,000,000.

Required Field

NAME OF SCHOOL:
ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE NUMBER:
EMAIL:
CONTACT NAME:
TITLE:
NCAA, NAIA, NJCAA:
DIVISION:
DATE PROPOSAL NEEDED:

INTERCOLLEGIATE, CLUB AND INTRAMURAL CATASTROPHIC COVERAGE OPTIONS

DEDUCTIBLE		MEDICAL MAXIMUM		CATASTROPHIC CASH
(CHOOSE ONE)		(CHOOSE ONE)		(CHOOSE ONE)

$25,000		$1,000,000		$1,000,000
$75,000		$2,500,000		$2,000,000
$100,000		$5,000,000		$3,000,000
BENEFIT PERIOD 10 Years

	MEN	WOMEN		MEN	WOMEN

ARCHERY			LACROSSE
BADMINTON			MARTIAL ARTS
BAND			RACQUETBALL
BASEBALL			RODEO
BASKETBALL			RUGBY
BOWLING			SKIING
BOXING			SOFTBALL
CHEERLEADING			SQUASH
CREW			STUDENT MGR
CRICKET			SURFING
CROSS COUNTRY			SWIM/DIVE
CYCLING			SYNCHRO SWIM
EQUESTRIAN			TENNIS
FENCING			TRACK & FIELD
FIELD HOCKEY			ULTIMATE FRISBEE
FOOTBALL, FLAG			VOLLEYBALL
FOOTBALL, TACKLE			WATER POLO
GOLF			WEIGHTLIFTING
GYMNASTICS			WRESTLING
ICE HOCKEY			X-COUNTRY SKIING
OTHER (PLEASE LIST)			OTHER (PLEASE LIST)











CURRENT CAT PREMIUM $