_____________________


_____________________
-- Follow us on --




_____________________

‘A’ Travel Registration

Liability Insurance


If you need a Certificate of Insurance to practice/play at a school, City Park or private facility, this is the form you need to fill out. Please fill out the form below and your certificate will be emailed to you within 24 hours. If you have any questions you can email Sandy Tudor or leave a message on my voice mail at (209) 663-2951. Your entire team MUST currently be insured/registered through USA to receive this certificate.

 
Team Name*:
Manager Name*:
Address*:
City*:
State*:
Zip*:
Home Phone*:
Example: 555-123-4567
Work Phone*:
Cell Phone*:
Email Address*:
Please provide all information below for site/facility where activities are to be held
Facility: Phone: - -
Contact Name: Fax : - -
Address: eMail Address:
City:
State:
Zip:
Enter additional comments below:
Enter Security Code:
captcha