Website Manager

Barrington Area Soccer Association

Secondary Insurance Claim Form

To submit a secondary insurance claim to Illinois Youth Soccer Association, you MUST do the following  (2) TWO steps:

Step 1. IYSA INSURANCE CLAIM FORM (CLICK LINK BELOW)

IYSA Insurance Claim Form 

NOTE: Once this has been filled in BASA/FCX will send the form to IYSA. Please email [email protected] once completed. 


Step 2. PULLEN INSURANCE SERVICES (CLICK LINK BELOW)
Pullen Insurance Services

NOTE: Must be filled out along with IYSA Insurance Claim Form before your claim can be filed.




Barrington Area Soccer Association

110 S. Hager St, Suite 203
Barrington, Illinois 60010
Phone : 847-381-2272
Email : [email protected]
Copyright 2011 FCB & FCX  |  Privacy Policy |  Terms of Use  |  License Agreement |  Children's Privacy Policy  Log In