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USA Touch Insurance Certificate Request
Please fill out the below information to request a Certificate of Insurance.
Certificates will be sent to registered USA Touch Clubs and Members only
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* Indicates required question
Club Name
*
Your answer
Club Contact
*
Your answer
Club Contact Phone
*
Your answer
Club Contact Email
*
Your answer
Certificate Holder (This is the VENUE requiring a COI, City of...Parks and Rec dept. etc. NOT an Individual)
*
Your answer
Address (The address associated with the Certificate holder, NOT your, or your teams address)
*
Your answer
City (of the Certificate holder)
*
Your answer
State (of the Certificate holder)
*
Your answer
Zip Code (of the Certificate holder)
*
Your answer
Name of Venue (if different than certificate holder name)
Your answer
Full Address of Venue (if different than certificate holder address)
Your answer
What is the purpose of this certificate? (Check all that apply)
*
Training Field
Match Field
Try Out / Camp
Tournament
Other:
Required
Is there a written contract in place?
Yes
No
Clear selection
Email Completed Certificate to?
*
Your answer
Also Email Completed Cert to?
Your answer
Special Wording or Instructions? - If you require an Endorsement, please list the form required.
Your answer
I Understand that Certificates of Insurance Are Only Valid for Registered Members of USA Touch
Yes
No
Clear selection
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