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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.




Contact

Barrington Area Soccer Association

110 S. Hager St, Suite 203
Barrington, Illinois 60010

Phone: 847-381-2272
Email: [email protected]

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