Use when non-Pony Club Members will be participating in a USPC activity (shows, clinics, etc.)
Application is hereby made for insurance to be provided in accordance with the terms and conditions of the Master Policy issued by AIG (American International Group, Inc.), and on file with the United States Pony Clubs, Inc. as follows:
USPC Optional Accident Insurance Application
Covering each non-Pony Club participant while he or she is taking part in a Pony Club Horse Show or other specified Special Event sponsored and supervised by the Pony Club.
Medical Expense Limit: $25,000 each accident Accidental Death & Dismemberment: $5,000
Specialty Program Insurors (SPI) A Division of Haas & Wilkerson Insurance 4300 Shawnee Mission Parkway Fairway, KS 66205 913-432-4400
We acknowledge receipt of the above Application and we have arranged for the insurance requested under the Master Policy issued for the United States Pony Clubs, Inc. The terms and conditions of the Policy shall control all coverage provided.