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W9 Federal Form   W-9 form must be filled out by referees, paid coaches, contract labor.

Insurance Information for Adult League Players

  1. Read Plan Summary for benefit information, link is found below.
  2. Print and complete all three pages of the Accident Claim Form, link found below.
  3. Contact Lois Stephens, LYSA Registrar  ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ), for verification of your registration.
  4. The referee report from the game in which you were injured is required, and is sent under separate cover.  Contact John Waizenhofer, league referee assignor ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ), to ensure this was completed and sent to KSA.
  5. A league official will need to sign off on the entire package before it's submitted. Please contact Allen Sharon,  the Adult League Director, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it to arrange for this. 
  6. Once all of the above steps is complete, mail your claim to: 

Peggy Polley, KSA President  

10809 Oreland Mill Road 

Louisville, KY 40229

 

Forms:

Accident Claim Form

Plan Summary

Claim Filing Instructions

 

 

 


If you have questions, feel free to email me (Tracey McGaughey) at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 859-223-5632.

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