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	For more information about coverage, please call us toll-free at 1-800-526-1379.

Request a Certificate of Insurance
(Standard Processing Takes 2 Business Days)

For any teams that have individually registered, please contact your ASA Commissioner for a certificate of insurance.

If your team purchased team insurance, please proceed.

If you need rush fax or email service, there is a $25 Rush Processing Fee. Please contact an ASA Customer Service Representative for further details.

*Your Name:
League Name:
Team Name:
*Mailing Address:
*City:
*State:
*Zip:

Your Phone Number:
*Your Email Address:

This certificate should be issued on behalf of (please indicate Team, League and/or Chapter name here):
Does the Certificate Holder need to be named as an Additional Insured?:	Yes No
Comments or Special Requests:

Certificate Holder Name:	(e.g., field owner, facility owner, township, etc)
Contact Name:
Certificate Holder Address:
City/State/Zip:

Certificate Holder Contact's Phone:
Certificate Holder Contact's Fax:

If you need rush fax service, there is a $25 Rush Processing Fee. Please contact an ASA Customer Service Representative for further details.
Name:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:

Umpire Clinic Workshop 2007 (PDF)