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The Worlds Largest Square Dance Organization

The Only National Dancer's Association Organized By Dancers For Dancers And Operated By Dancers
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USDA Dancers Insurance Program

These Forms Are For Use By USDA Affiliate Insurance Chairmen

Please Use These Forms If You Are Not Using The Portal
You May Fill In On Your Computer, Or Print & Fill In With A Pen

The Insurance Enrollment Form Must Be Mailed With Enrollment Check

 

  
 
 
How to use the USDA Insurance portalAdobe PDF Printable Copy11/18/22

Insurance Program Additional Information SheetAdobe PDF Printable Copy11/12/21

Federation or Association Club Enrollment FormAdobe PDF Printable Copy4/25/22

Club Roster FormAdobe PDF Printable Copy6/8/23

Club Members Insured Through A Different Club FormAdobe PDF Printable Copy6/8/23

Summary Form for Association/Federation Insurance Chairmen OnlyAdobe PDF Printable Copy12/12/23

Additional Dancer Enrollment FormAdobe PDF Printable Copy6/8/23

Inspection of Premises FormAdobe PDF Printable Copy8/8/07

Event Notification and Group Travel FormAdobe PDF Printable Copy9/3/08

Request for CertificateAdobe PDF Printable Copy7/13/09

Club Sponsored Class FormAdobe PDF Printable Copy8/12/07

Club Accident ProceduresAdobe PDF Printable Copy7/20/20

Accident Report FormAdobe PDF Printable Copy5/10/23

Part 1 and 2 InformationAdobe PDF Printable Copy8/12/07

Insurance Program Information TrifoldAdobe PDF Printable Copy9/17/19

Dancers Code of Ethics and Conduct TrifoldAdobe PDF Printable Copy8/30/18

USDA Officers and Committees Trifold - IS-07319Adobe PDF Printable Copy3/29/20

   
 
 
 
Or Contact Our:
 
Insurance Coordinator
Insurance Coordinator
Sanders

Eddie & Elizabeth Sanders
P O Box 417
Stephens, Georgia 30667-0417
Phone 706.759.3642

E-Mail: Insurance@usda.org

    

    

 

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11/12/21