2012 OBA INSURANCE PROGRAM APPLICATION FOR ENROLLMENT-MEMBERS
 ENROLMENT INCLUDES:
 1. LIABILITY AND ACCIDENT COVERAGE UNDER THE OBA POLICY
 2. RISK MANAGEMENT AND SAFETY PROGRAMS
 3. INSURANCE COVERAGE ONLY FOR OBA-SANCTIONED EVENTS (SEE 11.03 B OF THE OBA CONSTITUTION).*
 *ADDITIONAL FEES MAY BE REQUIRED
 Local Association:
 Affiliate:
 Contact Person:
First name Last name
 Street No.:
 Street Address:
 City:  Postal Code:
 Email Address:
 Telephone Res: ( ) -  Bus:  ( ) - ext.
ENROLLMENT INFORMATION
 Age Group House League Female Players House League Male Players Rep Female Players Rep Male Players Other Female Players Other Male Players Total
BlastBall:
T-Ball:
Rookie (Jr.& Sr.):
Mosquito (Minor & Major) :
Peewee (Minor & Major) :
Bantam (Minor & Major) :
Midget (Minor & Major) :
Junior:
Women:
Senior:
Other:
Total No. of Players:
1. TOTAL NUMBER OF PLAYERS X $3.10 PER PLAYER=
2. TOTAL NUMBER OF COACHES X $3.10 PER COACH =
3. TOTAL NUMBER OF UMPIRES
NOT INCLUDING OBA CARDED UMPIRES		 X $3.10 PER UMPIRE =
Total $
Name of Affiliated Association Secretary:

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