Certificate of Insurance Request
Part 1: Who is making this request?
Name
*
First Name
Last Name
Mass Soccer ID
*
Mass Soccer Team
*
Mass Soccer League
*
Bay State Soccer League
Brockton Sunday League
Cape Cod Soccer League
Central Mass Coed Recreational Soccer League
Central Mass O35
Central Mass Twilight
Chelsea Soccer League
Eastern MASS Women's Soccer League
Football Alliance of New England
Mass Adult Futsal
Mass Soccer Indoor League
Mass State Referee Committee
Massachusetts State Soccer League
New England Over-the-Hill Soccer League
New England Champions League
New England Soccer League
Old Colony Women's Soccer League
Twilight Summer League
USAfrica
Vineyard Football Association
Other (non-league)
Which Division?
*
Required for NEOTHSL. N/A for others.
Part 2: What facility are you using?
List specific site/field(s) your are requesting:
*
Ex. Alpine Field, Middle School, High School Turf
Who OWNS the facility that you are reserving?
*
Typically town/city, college or private school.
Address of OWNER (NOT usually the address of the site.)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Part 3: Where should we send the certificate?
Attention:
*
First Name
Last Name
E-mail:
*
Submit
Should be Empty: