INSURANCE APPLICATION

Team Information

Please conplete the information below,
and the information on the roster page.
Print both forms and mail with your Total payment to:

American Fastpitch Association
2926 Calle Frontera
San Clemente, CA 92673
(949) 366-0213
STATE:

TEAM NAME:

CONTACT FIRST NAME:

CONTACT LAST NAME:

ADDRESS:

CITY, STATE, ZIP:

HOME PHONE / AREA CODE:

CELL PHONE / AREA CODE:

EMAIL:

AGE DIV:

CLASSIFICATION:

CATAS:

ADDITIONAL INSUREDS
You will receive an Insurance card in the mail.

Thank you for your participation.
Click here for Team Roster
ADDITIONAL INSUREDS (Park or City not individuals)
Fill out if needed for Insurance Application only (1 free, 2 or more at $25.00 each)
1.

2.

3.

4.
NAME                ADDRESS              CITY               ST       ZIP                FAX
Make sure you submit your Total payment for Insurance.
Your Insurance will not go into effect until paid in full.