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Insurance

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THIS PAGE HAS BEEN UPDATED FOR 2024!



INSTRUCTIONS

Updated Insurance Forms were obtained in April, 2024 from the United Square Dancers of America website.
These new forms are provided in the table below. Each form is an Acrobat .pdf file
that can be filled in online, saved and printed --OR-- printed and completed by hand.

When filling out forms please put names in alphabetical order.

All forms requiring money or a signature must be mailed (with the check) to your Association Insurance Chairperson.
Clubs should address all correspondance to their Association Insurance Chairperson.

For 2024 the insurance premium is $5.50 per member with a minimum club fee of $46.00.
Therefore smaller clubs, 8 members or less, are a flat $46.00 for the club.


Each Association Insurance Chairperson will forward the forms to the Florida Federation Insurance Chairperson.

Florida Federation Insurance Coordinator
Carol Poole
1541 Lakeside Drive
DeLands, FL 32720
(386) 717-0870
Northwest Association Insurance Coordinator

Alec & Kay Schmidt
116 Bayou Drive
Niceville, FL 32578
(850) 865-8105
Northeast Association Insurance Coordinator

Linda Tester
22 Sandra Drive
Jacksonville Beach, FL 32250
(904) 707-3117
Central Association Insurance Coordinator

Keith & Angie Olds
4549 Canard Road
Melbourne, FL 32934
(321) 253-9817
Southeast Association Insurance Coordinator

Bob Dodes
7402 Kea Lani Drive
Boynton Beach, FL 33437
(561) 877-6067
WestCoast/SCC Association Insurance Coordinator

Carol Poole
1541 Lakeside Drive
DeLands, FL 32720
(386) 717-0870

Insurance Program Overview
PDF Version
This is a 2 page document
Part1 and Part 2 Coverage Summary Information
PDF Version
This is a 2 page document
How To File A Claim & Additional Insurance Information
PDF Version
This is a 3 page document
USDA Insurance Frequently Asked Questions
PDF Version
This is a 3 page document

For Club Insurance Coordinators

ADOBE.pdf

SUBJECT
Club Roster Club Roster
Additional Enrollment Additional Enrollment
Class Roster Club Class Roster
Another Club Club Members Insured
Thru Another Club
Request for Certificate Request for a Certificate
Event or Travel Event or Group Travel
Inspection Inspection of Premises
Club Accident Procedures Club Accident Procedures
Accident Report Club Accident Report

For Association Insurance Chairpersons

ADOBE.pdf

SUBJECT
Cover Sheet Cover Sheet
Club Enrollment Form Club Enrollment Form

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