Skip to main content
Skip to main Navigation
Skip to Search
Contact Us
=
Main Sections
Home
About Us
RPS Bollinger Key Staff
Products & Programs
Forms & Apps
Contact Us
Contact Us Form
Request a Claim Form
Your Current Location in the Site
Account Request
There was a problem with your submission.
Errors have been
highlighted
below.
Please complete the form below to receive a Certificate Administrator's login and password on
RPSBollinger.com
.
Your First Name:
Your Last Name:
Phone:
Extension:
Organization Name:
Address:
Address 2:
City:
State:
Please Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Select Your User name:
Password:
Password Confirmation:
Email Address:
Email Address Confirmation:
I certify that the team/league or event for whom I am requesting this certificate mandates 100% membership in USA Lacrosse, and that I have verified our team/league's roster and all players and coaches are current members of USA Lacrosse.
I certify that the above is true and I understand that a roster will be required in the event of a liability claim in order to confirm membership. I understand that liability claims will only be covered if the team/league or event carries 100% membership in USA Lacrosse.
Password Requirements
Your password must be:
at least 7 characters
no more than 20 characters
must include at least one upper case letter
one lower case letter
and one numeric digit