In order to have your event covered by SMAC insurance, we will need all of the following information 2 months prior to the event. With questions, please contact Marisa McLeod at marisamcleod@ymail.com, who is SMAC-LA's insurance liason with the state. She can help you with the process. 

Date of application *
Date of application
Event (Start) Date *
Event (Start) Date
Event End Date (if multiple days)
Event End Date (if multiple days)
Time *
Time
Name of Event Director (ED) *
Name of Event Director (ED)
Address of ED *
Address of ED
Phone of ED *
Phone of ED
Address of Venue *
Address of Venue
Phone of venue contact
Phone of venue contact
ED must ask for the venue insurance requirements. If they have insurance requirements, please include a copy of that with this application. *
For example, this document is often called, "Insurance Requirements for Short Term Lessees." Please email this directly to ssteitz@suzukimusiclosangeles and cc marisamcleod@ymail.com
Please list all sources of income and estimated receipts from participation; please list any sources of donation expected. Please describe and then list amount: i.e. Registration/ticket sales - $600
Please list all expenses associated with the event. All expense items should be broken down by category. In addition, each person to receive SMAC funds for services rendered should be individually listed, a description of the services each is to perform, and the estimated cost or rate of compensation. Please itemize all expenses below: (cost o fmusic, compensations, rent, food/meals, legal, travel, insurance, postage, secretarial, supplies, paypal fees (3%)
Please indicate ALL of the information of those involved with the event. All listed will need to undergo a sexual assault training and background check. Please list PERSON/EMAIL/ROLE/RATE OF COMPENSATION/NUMBER OF HOURS/event director, independent contractor, volunteer/Resident of which SMAC branch/Membership status current?

Additional steps:

1. If a volunteer is driving to collect supplies or for "SMAC business," we will need proof of automobile insurance sent directly to the insurance director (NOT the small card to carry in your car, but instead the copy of the Automobile Policy Delarations page indicating bodily injury coverage of at least 100,000/300,000.)
2. We will also need the Statement of Acknowledgement and Agreement by each ED/IC/VO listed on the Event Roster
3. Finally, we will need a copy of branch approval minutes.
 

Links for the Abuse prevention system requirements, an online process, will be emailed after this completed form has been forwarded to the SMAC Insurance director. Abuse prevention system requirements consist of:

1. Sexual abuse awareness training taken by all working on this event, in contact with children; the event director; independent contractors, and volunteers (renewable every two years). 2. background check completed by all working on this event, in contact with children; the event director, independent contractors, and volunteers (renewable yearly) 3. policies and procedures, read and signed by all in tact with children; the event director, independent contractors, and volunteers. (renewable yearly)

Protocol for after the event:  please submit a copy of the flyer, ticket programs, and other advertising for proof of sponsorship. Please submit a financial report for submission to board meeting minutes. Branches, institutes, and chapters will be billed individually for the training and background checks connected to their events. budget (approximately $28 per person)