United States Specialty Sports Association
Insurance Program

Only Visa or MasterCard is accepted for on-line payments.

Choose Insurance Coverage Type, fill out form. Then click the "I hereby" button at the bottom of page. You will be taken to a secured site for Credit Card Payment.

Note: There is an additional $10 charge for online processing. $10 will be added to the prices below.

Age Group determined by the age of the oldest child on the team at the time of purchase.

Insurance Coverage Type

Indicates Required

Team Name:

USSSA Team Registration Number:

Registration # Help, Use only Numbers. If your registration number begins with "G" omitt the letter "G", for example G12345689 should be inputted as 123456789 only.

Contact First Name:

Contact Last Name:

Contact Address:

Contact City:

Contact State:

Contact Zip Code:

Contact Phone:

I.E. : 410-555-1212

Contact Email Address:

Complete items below only if field/facility owner requests additional insured status. Below there are text boxes to add one field/facility owner. If you have more then one field/facility owner, please email requests for additionals to insurance@usssa.com. Make sure you include your team name and payment confirmation number with the additional field information. You will receive this confirmation number after paying online.

Name of Field/Facility Owner:

Address:

City:

State:

Zip:

Contact Person:

Phone:

I.E. : 410-555-1212

United States Specialty Sports AssociationInsurance Program

United States Specialty Sports Association
Insurance Program