Fillable PARTICIPANT ACCIDENT MEDICAL CLAIM FORM - USA Water Ski - usawaterski

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PARTICIPANT ACCIDENT MEDICAL CLAIM FORM SEND COMPLETED FORM TO: American Specialty Insurance & Risk Services, Inc. P.O. Box 459 Roanoke, IN 46783 (800) 566-7941 Telephone (260) 673-1291 Facsimile This form is required to submit a Participant Accident medical claim for injuries sustained during a USA Water Ski sanctioned event. PLEASE ANSWER ALL QUESTIONS. INDICATE "N/A" IF INFORMATION IS NOT...
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