Request for Conference Insurance

All IEEE sponsored and qualifying co-sponsored conferences are required to complete and submit the following form.

This form must be completed in full and submitted with the Conference Budget. Budget approval will not be granted until the completed form is received. All forms must be received no later than 90 days prior to the start of the conference. A list of Conference Officers and Committee Members must accompany this form.

IMPORTANT: Please read carefully about our coverage (opens in new window) before filling out this form.

Conference Name:

Conference Dates:
Conference Center:

Conference Location (City, State, Zip Code, Country):

Conference is financially Co-Sponsored with a NON-IEEE Organization: Yes No
Co-Sponsor Name(s):

The coverage listed below, with the exception of On-site Robbery, will be furnished to the conference at no charge except where additional coverage is requested:

Bodily Injury & Property Damage:	$ 1,000,000 USD ($5,000 USD Deductible)
Rental Equipment - within the U.S.(includes Canada, Puerto Rico & U.S. Territories):	$ 500,000 USD($10,000 USD Deductible)
Rental Equipment - outside the U.S.:	$ 200,000 USD ($1,000 USD Deductible)
Comprehensive Business Crime:	$ 5,000,000 USD ($100,000 USD Deductible)
Limited Volunteer Personal Liability:	$ 1,000,000 USD ($5,000 USD Deductible)

Charters: IEEEs Liability coverage does not apply to charters (boats, planes, buses, or other vehicles). * Please read the special note regarding Charters. *
Certificate of Insurance: You may be required to furnish evidence of insurance to a third party. If so, please complete the following:
Description of Third Party:
Third Party Name:
Third Party Address:

Third Party Contact Info:

Please be sure to include the specific insurance requirements as included in the third party agreement.

Conference Chair or Treasurer:
Name:
Address:

Phone:

Fax:

E-mail:

Date:

Submitted by:

* E-mail:

* - REQUIRED

* Please print a copy and retain for your records.*

Please feel free to contact us if you have any questions:

IEEE Conference Services
445 Hoes Lane
Piscataway, NJ 08854, USA
+1 732 562 5541 (phone - Insurance Office)
+1 732 981 1769 (fax)
conference-services@ieee.org (e-mail)