CCASA Registration Password Form

Please complete the form below to obtain a user Name and Password to access the CCASA Individual Insurance/Registration web site.

Please note, The release of liability form has been singed by each registered players parent or guardian and is on file at with the league prior to beginning the inputting of participants.

All fields with * are required

Please provide User information below. This is the person responsable for inputing information for the league. If you have any questions, please contact Bart Magellan at (209) 639-7353.

*League Name:

*Home Phone:

*Contact Name:

*eMail Address:

*Address:

*User Name:

*City:

*Password:

*State:

* Zip:

Web Site/URL:

Please provide League information below.

*League President:

*City:

*League Address:

*State:

* Zip:

*League Phone #:

*League Email:

Enter additional comments below: