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Tournament Team Insurance Form

After you click Submit Application at the bottom of the screen the next page will be payment and the third page the roster download.  Please read the instructions.

Note that unless we have received your roster so we know what players we are insuring the insurance coverage will not apply.  Also you must take the approved roster you receive back from us to the tournament check-in.  This special insurance coverage is only valid until the conclusion of the tournament. 

Please submit any questions to insurancequestions@usclubsoccer.org.


*Your Club's Name:
*Club Address:
*City:
*State:
*Zip:
*Phone:

 
*Your Team Name:
*Age Group:
*Your Name:
First Last
*Your Position:
*Your Email:
*Your Day Phone:

 
*Team Coach Name:
First Last
*Coach's Email:
*Coach's Phone:
*Name of tournament you are attending:
*Name of Host Club:
*Dates you are attending:  
mm/dd/yyyy mm/dd/yyyy


Click the "Submit Application" button to proceed to the Application Payment Page.