REQUEST A CERTIFICATE

Use the form below to request a certificate of insurance for approved/insured activities. A list of organizations/names will appear when you start typing the name, city, or state code.

NOTE: New organizations/new names will be unable to utilize this certificate request form. If your organization or name does not appear when attempting to enter your information in the first data field listed, please contact Molly Vaughan (admin@nebraskastatesoccer.org) for additional assistance.

Please allow a minimum of 3-5 business days for review and processing of your certificate request. Once your certificate request has been processed, you will receive an email message confirming approval of your request and a copy of the certificate of insurance or a denial message if necessary.

Please be sure to check your Junk/Spam email folder for this communication as many email systems (AOL, Gmail, Yahoo, etc.) recognize this message as a system automated email.

If your request is urgent, please contact Molly Vaughan (admin@nebraskastatesoccer.org) for assistance and note that additional expediting and service fees may apply.

Governing Body
Governing Body: Alliance Management Group, LLC. (Nebraska State Soccer Association)
* Organization/Club/Name: help
* Type of Certificate: help
Event Details
* Event Name: help
* Start Date: help
* End Date: help
Certificate Holder
* Holder Name: help
* Address (1):
Address (2):
* City:
* State:
* ZIP Code:
* Certificate holder's interest: help
Contact Information
* Contact Name: help
* Contact Phone:
* Contact Email:
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