Special Events Insurance Application | Michigan Catholic Conference

Please be aware that notification of an event must reach the Michigan Catholic Conference at least 72 hours in advance of the event. Once MCC has received the check and verified all of the information, the individual or organization requesting coverage (host/named insured) and unit (additional insured) will each receive a copy.

Required fields are marked with a *

Individual or Organization Requesting Coverage (Host/Named Insured) Information

Host First Name* Host Last Name* Host Email* Organization Only required if host is requesting coverage for an organization Phone* Address* City* State* Zip Code*

Unit (Additional Insured) Information

Contact First Name* Contact Last Name* Contact Email* Unit Name* Unit No.* Address* City* State* Zip Code* Check No.* Please make checks payable to Michigan Catholic Conference and mail to:
Michigan Catholic Conference
PO Box 670986
Detroit, Michigan 48267-0986

Event Information

For repeating events or events lasting more than one day, please use the ‘Additional Event Dates’ section below.

Date* Type* Starts at* Ends at* Number of participants* Food is being served Alcohol is being served

Additional Event Dates

If applicable, list additional dates for repeating events or events lasting more than one day.

Date Date Date Date Date Date