INDEPENDENT SOFTBALL ASSOCIATION - 2010

TEAM INSURANCE ENROLLMENT FORM

1-800-447-6797

TEAM OR LEAGUE NAME______________________________________________

INSURED SPORT (CIRCLE ONE): SOFTBALL BASEBALL

COMPLETE ONLY IF FIELD OWNER REQUESTS ADDITIONAL INSURED STATUS

PURCHASE ONLINE AT: WWW.ISASOFTBALL.COM

OR

MAKE CHECK PAYABLE TO: CHAPPELL INSURANCE AGENCY &

MAIL TO: 25807-A COX ROAD, PETERSBURG, VA 23803

Certificates will be emailed. If email not available then faxed

EMAIL ADDRESS:__________________________________________________________

FAX #:_____________________________________________________________________

ALL RATES INCLUDE AN ADMINISTRATION AND MEMBERSHIP FEE.

$5.00 ADDITIONAL PROCESSING FEE FOR CREDIT CARD PURCHASE.