Single Student Intro Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Single Student Intro Registration

For registering a single student for intro insurance. FOR BULK REGISTRATION, refer to the section listed under member resources on the HEMAA website.

Sign in to Google to save your progress. Learn more

* Indicates required question

Affiliate Club Name *

Your answer

Submitter's Name *

Your answer

Submitter's Email *

Your answer

Student's Name *

Your answer

Student's Email Address *

Your answer

*

I understand that student's will only be covered from the date of upload to 60 days past the upload date, and that any claims on incidents occurring prior or after that time frame are invalid.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of HEMA Alliance. Report Abuse