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Claims Information
New Mexico Youth Soccer Association
Administered by Bollinger and R.A.D. Insurance Group

Blank Claim Form

If you would like a blank claim form, please select your accident date below and then press “Print Blank Claim Form”.

*Accident Date




Instructions:

  1. Complete the claim form
  2. Once completed and signed, mail it to the address listed on the top left of the form.

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