Charter/accident Insurance Change Application Form Page 2
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2CHARTER/ACCIDENT INSURANCE CHANGE APPLICATION
If after completing registration your league needs to make adjustments to its Charter and Accident Insurance
number, you can edit online through the Data Center or provide the information below:
NOTE: The deadline for all adjustments is June 1, 2016.
League Number: ___________________________________
Date: _____________________________
League Name: _________________________________________________________________________
President’s or Officer’s Name: _____________________________________________________________
Phone Number or E-mail: _________________________________________________________________
Original App #
Baseball Division
Change # to
LL Major
Intermediate (50/70)
Junior
Senior
Big
Challenger
Sr. Challenger
Tee Ball
LL Minor
Original App #
Girls Softball Division
Change # to
LL Major
Junior
Senior
Big
Tee Ball
LL Minor
Original App #
Boys Softball Division
Change # to
LL Major
Senior
Big
Tee Ball
LL Minor
Please indicate if you wish to add the following insurance coverages:
o Crime
o Liability (General Liability and Directors and Officers Liability)
If you need to cancel the following insurance policies - Liability or Crime - please contact the Liability Department
at 570-326-1921, ext. 2211 or 2265. Your Charter and Accident Insurance information will be adjusted to reflect
your changes. In addition, your league account will be billed or credited for the proper amounts.
Signature _____________________________________________
Sign form and fax to 570-322-2376 or mail it to Little League International, Attn: Charter Changes, 539 US Highway 15, P.O. Box 3485, Williamsport, PA 17701-0485
05-01-16
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