National Association of Rocketry

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NAR Insurance Claim Form

Please provide preliminary information on your NAR Insurance Claim by completing the form below. Please be as complete and accurate as you possibly can in filling out this form. After reviewing this initial report, NAR Headquarters and / or the NAR Insurance Agent will contact you directly for additional details and instruct you as to the next steps required to complete your claim. Please note that NAR Headquarters and our agent's offices are both open only during normal business hours, 9-5 Central Time. Should you file a claim during the weekend, you may not receive a call until the following business day.

After completing the form, be sure to hit the "SUBMIT" button below.

If you have questions, you may call or email Bob Blomster at the J. A. Price Agency: (952) 944-8790, Ext. 127.

Member Information - Provide complete information on the NAR member involved in this incident.

Name:	NAR #:
Street:
City:	State: ZIP:
Phone:	E-mail:

Section Information - If an NAR section was involved, please provide complete information on the section involved in this incident.

Name of Section:
Abbreviation:	Section #:
City, State, ZIP:

Incident Information - Please provide information on where this incident took place.

Location Name:
Location Owner:
Street:
City, State, Zip:
Phone:	E-mail:
Date and Time of Incident:

Description - Please provide a description of this incident, including the persons involved, any important details of the accident, and the nature of any damange or injury sustained.