Certificate of Insurance Request

Certificate of Insurance Request
Part 1: Who is making this request?
Name*

First NameLast Name
Mass Soccer ID*
Mass Soccer Team*
Mass Soccer 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

CityState / Province

Postal / Zip Code
Part 3: Where should we send the certificate?
Attention:*

First NameLast Name
E-mail:*
Should be Empty:

Part 1: Who is making this request?