Purchase BPA Tournament Insurance Plan
Rates Effective: 8/1/24 - 8/1/25

Instructions:
Please enter the information below to complete the application for the Tournament Insurance Plan. Once you have entered the required information click the button below 'Continue to Payment' and you will be brought to the payment gateway.

All highlighted fields are required to continue.

Please Allow 24 - 48 hours for processing

Number of teams *

X Rate (Adult $25, Youth $10) *

= Total Premium Due

Start date of tournament: *

End date of tournament: *

Tournament Name: *

Host Team Coach Name *

Host Team Name: *

Mailing Address: *

City:*

State:*

Zip: *

Email: *

Phone: *

Tournament Facility Name: *

Tournament Facility Address: *

City:*

State:*

Zip: *

Phone: *

Email:*

To the attention of:

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Premium is fully earned on the effective date of coverage. No pro-rata refunds will be made. Membership includes insurance premiums & association fees. I understand and agree that (a) if this application is accepted by the Company, coverage will begin on the date of acceptance or the date requested in the application, whichever is later, subject to payment of the required premium; and (b) Premium computation is subject to audit. Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Please check the box to verify and agree that the information provided herein is true and complete.
I Agree

Purchase BPA Tournament Insurance PlanRates Effective: 8/1/24 - 8/1/25

Purchase BPA Tournament Insurance Plan
Rates Effective: 8/1/24 - 8/1/25