U.S. Ski & Snowboard Incident Input
FIRST REPORT OF INCIDENT
* Denotes a Required Field
Report should be completed/submitted by Event Organizer, Official, or Coach (with no relationship to Claimant)
Event Organizers: Please complete all required fields to the best of your ability. A claim cannot be started without this information. Please note that completing this form is not a guarantee of coverage.
Coverage Underwritten By:
Mutual of Omaha Insurance Company
Mutual of Omaha Plaza
Omaha, NE 68175
Injured Person Information
Employer and Address Information
Guardian/Parent (If Injured Person is a Minor)
Information Regarding the Individual Completing This Form
Report should be completed/submitted by Event Organizer, Official, or Coach (with no relationship to Claimant)
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