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Balance for Cyclists | Event Injury Insurance & Cancellation Protection Quote Machine
Hi! Please use this form to get a quote for Event Injury Insurance & Event Cancellation Protection Plans. You can choose to ask for either program, or both.
9
Questions
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1
CONTACT INFORMATION
Please enter your contact details.
Contact Name
Contact Email
Contact Phone
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2
BUSINESS INFORMATION
Please enter your client or business details.
Business Name
Business Street Address 1
Business Street Address 2
Business City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other US Territory
Not in US
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other US Territory
Not in US
Business State
Business Zip Code
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3
EVENT INFO (1) | NAME & LOCATION
Please enter details about the event.
Event Name
YES
NO
YES
NO
Is the Event Address the same as the Business Address?
Event Street Address 1
Event Street Address 2
Event City
Event State
Event Zip Code
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4
EVENT INFO (2) | DATES
Please enter the dates of your event here.
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5
EVENT INFO (3) | PARTICIPANTS
How many participants will there be?
Enter Number of Participants
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6
EVENT INFO (4) | DESCRIPTION
In a few words, please tell us about your event.
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7
EVENT INJURY INSURANCE
Would you like to get a quote for Event Injury Insurance?
YES
NO
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8
EVENT CANCELLATION PROTECTION
Would you like to get a quote for Event Cancellation Protection?
YES
NO
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9
EVENT TYPE
What type of ride is this?
Road Ride/Race under 100 Miles
Road Ride/Race over 100 Miles
Mountain Bike Ride/Race
Trail Ride for Road Bikes
Tour
Cross Country Fundraiser
Club Ride
Ultra Marathon
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10
TERRAIN
Please select the terrain that best matches your event.
Flat
Hilly
Mountains
Mixed
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11
SURFACE
Please select the surface that best matches your event.
Paved
Groomed Trail
Ungroomed Trail
Mixed
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12
COURSE SUPERVISION
How will your event's course be supervised?
Closed - Police Supervised
Closed - Volunteer Supervised
Open - Police Supervised
Open - Volunteer Supervised
Open - Unsupervised
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13
SEASON
In what season will your event take place?
Winter
Spring
Summer
Fall
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14
TIME
Will your event take place during the day or night?
Day
Night
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15
DURATION
How long is your event?
Single Day
Multi Day
24 Hour
Recurring
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16
DIFFICULTY
Please select the difficulty that best matches your event.
Technical
Non-Technical
Mixed
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17
RIDER EXPERIENCE
Please check all boxes that match your riders' experience level.
Professionals
US Cycling Cat Riders
Amateurs
Novices
Seniors (over 60)
Youth (under 18
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18
ACCIDENT HISTORY
Please select the accident history that best matches your event.
No Accidents
Accident(s), no serious injuries
Accident(s), with serious injuries
No Previous History
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19
EVENT CANCELLATION (1) | INSURED VALUE
Does the Sponsor(s) elect to insure the Total Expenses, Total Gross Revenue or another amount?
Total Expenses
Total Gross Revenue
Another Amount
Total Expenses
Total Gross Revenue
Another Amount
Choose One
Enter the Amount to be Insured in USD
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20
EVENT CANCELLATION (2) | HISTORY
Has this Event been held before? If yes, how many times in all, at this location, and at this time of year?
Yes
No
Yes
No
Has this Event been held before?
How many times?
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21
EVENT CANCELLATION (3) | REFUND POLICY
Do you have a Participant Refund Policy?
Yes, there is a refund policy.
No, there is not a refund policy.
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22
EVENT CANCELLATION (4) | ADVANCE SIGN UPS
What percentage of participants sign up or / revenue generated in advance of the Event?
Enter a percentage.
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23
EVENT CANCELLATION (5) | SET UP TIME
How much set up time, in hours, is needed before the Event begins?
Enter the hours of set up time.
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24
EVENT CANCELLATION (6) | PAST INCIDENTS
Has this or any Event in which the Sponsor(s) was involved in managing had any incident that resulted in any of the following? (Check all that apply.)
Cancellation
Abandonment
Postponement
Interruption
Curtailment
Relocation
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25
EVENT CANCELLATION (7) | PAST INCIDENTS
If you selected any option from the previous question, please explain here.
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26
EVENT CANCELLATION (8) | POSSIBLE INCIDENTS
Are you aware of any matter, fact, circumstance or incident existing or threatened that might reasonably result in Cancellation, Abandonment, Postponement, Interruption, Curtailment or Relocation of the Event(s)?
Yes
No
Yes
No
Choose One
If you answered yes, please explain here.
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27
CALC: NUMBER OF DAYS
(This should not be visible in the live form. Used to calculate final pricing.)
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28
CALC: PARTICIPANT DISCOUNT
(This should not be visible in the live form. Used to calculate final pricing.)
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29
CALC: EVENT TYPE FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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30
CALC: TERRAIN FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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31
CALC: SURFACE FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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32
CALC: COURSE SUPERVISION FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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33
CALC: SEASON FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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34
CALC: TIME FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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35
CALC: DURATION FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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36
CALC: DIFFICULTY FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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37
CALC: RIDER EXPERIENCE FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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38
CALC: ACCIDENT HISTORY FACTOR
(This should not be visible in the live form. Used to calculate final pricing.)
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39
CALC: RISK MULTIPLIER
(This should not be visible in the live form. Used to calculate final pricing. Sum of factors.)
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40
COST: PER RIDER PER DAY
(This should not be visible on the live form.)
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41
COST: PER RIDER DURATION
(This should not be visible on the live form.)
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42
COST: DAILY PREMIUM
(This should not be visible on the live form.)
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43
COST: TOTAL PREMIUM
(This should not be visible on the live form.)
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Balance for Cyclists | Event Accident & Cancellation Quote Machine
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