IFA-VTD "UMPIRE" INJURY CLAIM FORM
Umpires MUST be a registered IFA-VTD umpire at the time of the injury and umpiring an IFA-VTD sanctioned tournament in order to be covered with insurance. When you are finished filling this form out, please hit the "SUBMIT" button at the bottom of the form.
Umpire Full Name *
First / Last Name of Umpire Injured
Your answer
Umpire ID# *
Your umpire ID# is located on your ID card issued at the time of registration
Your answer
Umpire Mailing Address *
Number and street name
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Umpire Phone Number *
Include Area Code
Your answer
Umpire Email Address *
Your answer
Date of Injury *
Month / Day / Year
Your answer
Brief description of the injury *
Insufficient information could lead to a delay in obtaining your signed claim form.
Your answer
Submit
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