Certificate of Insurance Request

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 *
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: *
Should be Empty:

Part 1: Who is making this request?