Pony Club

USPC Optional Accident Insurance Application

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.

EXCLUSIONS: Roughstock

Medical Expense Limit: $25,000 each accident
Accidental Death & Dismemberment: $5,000

to

$28.00

$28.00

Total: