Federation of Broomball Associations of Ontario

 

Insurance

Insurance is provided by All Sport Insurance Marketing Ltd.

 

Please send the original completed form along with any invoices for expenses you had to pay yourself to:

 

Lisa Roehler 

9958 Forest Glade Court 

Windsor, ON  N8R 2B9 

Tel: 226-346-5516 

email: roehlerl@hotmail.com

 

 

Form:  Accident Claim Form


Note:
   CERTIFICATION OF ASSOCIATION OR CLUB EXECUTIVE section will be completed by the F.B.A.O. Secretary. Please do not fill in any section of this box in any way. Do not send your claim directly to All Sport as they will not be able to process it.