Claim Form

If you would like a blank claim form, please select your accident date below and then press “Print Blank Claim Form”.

  • *Accident Date

    As of January 1, 2023 RPS Bollinger is no longer the Administrator for the USA Lacrosse Program.
    For injuries incurred January 1, 2023 and after please contact
    USA Lacrosse Membership: 410-235-6882 x102.