REQUEST FOR CERTIFICATE OF INSURANCE

If you are in need of a Certificate of Insurance for your club or a facility you are utilizing, please complete this form for one insured facility request and this form for multiple requests, and return to your regional administrator. Allow a minimum of three business days for processing. Certificates of insurance are valid for a calendar year, and can be issued for the upcoming year beginning in late December.

The completed form should be sent to

Rachel Burroughs, US Club Representative 
843-429-0006 ex 321
AdminRegionB@usclubsoccer.org