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2012 TEAM Ins Enrollment Form
2012 Tournament Ins Enrollment Form
2012 NASF Clinic Enrollment Form
2012 NASF Officials Insurance Form
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2012 NASF TOURNAMENT Insurance Enrollment Form
Fields indicated with a
*
are mandatory.
*
Contact Name:
*
Email:
*
Home Phone:
Evening Phone:
*
Address:
*
City:
*
State:
*
Zip:
Indicate Sport:
Softball
Baseball
Basketball
Flag/Touch Football
Golf
Soccer
Frisbee
Volleyball
Tackle Football
Wrestling
Officials
Other
*
Indicate Age Group:
Youth 12 & Under
Youth 13 - 19
Adult
Other Sport:
Tournament Dates:
Tournament Name:
Tournament Location:
Please Use one Form to Sign up multiple teams in Tournament.
Put Team Names, Managers Name, Managers Email (Use Comment Block Below if Needed!)
Team Name 1:
Manager Name 1:
Manager Email 1:
Team Name 2:
Manager Name 2:
Manager Email 2:
Team Name 3:
Manager Name 3:
Manager Email 3:
Team Name 4:
Manager Name 4:
Manager Email 4:
Team Name 5:
Manager Name 5:
Manager Email 5:
Team Name 6:
Manager Name 6:
Manager Email 6:
Team Name 7:
Manager Name 7:
Manager Email 7:
Team Name 8:
Manager Name 8:
Manager Email 8:
Team Name 9:
Manager Name 9:
Manager Email 9:
Team Name 10:
Manager Name 10:
Manager Email 10:
Team Name 11:
Manager Name 11:
Manager Email 11:
Team Name 12:
Manager Name 12:
Manager Email 12:
Team Name 13:
Manager Name 13:
Manager Email 13:
Team Name 14:
Manager Name 14:
Manager Email 14:
Team Name 15:
Manager Name 15:
Manager Email 15:
Team Name 16:
Manager Name 16:
Manager Email 16:
* Additional Teams, Insured, or Comments
(Each Tournament has a $125.00 minimum premium).
Insurance Cost:
# of Teams:
Times
Cost Per Team:
$
=
Total Cost:
$
Annual NASF Team Registration:
# NASF Teams:
Times
$10.00 Per Team:
=
NASF Registration Cost:
$
The annual $10.00 NASF membership fee per team or official will be collected with your insurance enrollment.
Make Check payable to:
For Credit Card Information:
Special Markets Insurance Consultants
2615 Post Road
Stevens Point, WI 54481
Email:
NASF@specialmarkets.com
Special Markets Insurance Consultants
2615 Post Road
Stevens Point, WI 54481
Phone: 800-727-7642 ext 311
Fax: 715-344-6126
