U”SDA Insurance Program For Clubs and Dancers

 Protection Includes  Accident & Liability Coverage

Although safety rules are closely followed, accidents will happen. Accident & Liability Insurance helps protect club members from financial loss due to a covered accidental bodily injury. Liability insurance protects the club and its members and association officials from financial loss due to unforeseen incidents which may develop into litigation against members and dance organizations.

Eligibility, Premium & Policy Term

 Dancers of GSSDA member clubs are eligible for USDA insurance at the current price rate of $4.85 per person per year with a minimum rate of $45.00 per club. 100% of a club’s membership must be covered by this policy for it to become effective. The insurance policy runs from January 1st to December 31st. People belonging to more than one club need to pay only one fee and will be covered while dancing at any other club’s sponsored dances. This policy does not cover callers/cuers or their equipment while they are calling/cueing. The policy does cover callers/cuers if they are dancing to another caller/cuer and they are  included on the club roster and the club member rate has been paid. A summary of coverage can be viewed at USDA.org.

All clubs and Federations must be a member of GSSDA, annual dues are $20.00 payable to GSSDA before enrolling their club for annual coverage.  GSSDA Membership Form on GSSDA website www.gssda.org

 Instructions for Obtaining Coverage

 Send one (1) copy of the Federation or Association Club Listing form: [Click for PDF]

 On this form, the From Information for the Federation” should read as follows:

 Name of Association: Georgia State Square Dancers Association

Name of Insurance Chairman: Pat Inglis

Address of Insurance Chairman: Pat Inglis, 1340 Oakengate Drive, Stone Mountain, GA 30083. Phone Number of Insurance Chairman: 404-294-0268; email inglisp@bellsouth.net

On this form, the “Information for the Club” should include the following:

 Club Name: Total number of members

Club mailing address: address where the policy should be sent

Phone Number and email address for insurance chairman of club

Location of any facility being used for dances (please use the 911 address) for 2020. Include on the form any special dances, exhibitions, or demonstrations such as nursing homes, malls, churches, etc. If the owner of a building or facility where you will be dancing requires coverage you must furnish their complete name and address.

Send one (1) copy of the club membership list (roster) with 100% of the club members listed.  Please note on the roster any member who belongs to another club (give club name) through which his/hers insurance will be paid.

Check for $4.85 X number of dancers the club is insuring (a minimum of $45.00 per club must be submitted).

Send to the GSSDA Insurance Chairman at the following address: Pat Inglis, 1340 Oakengate Drive, Stone Mountain, GA 30083

 The following forms may be needed during the year.  All these forms will need to be completed and either sent via US mail or e-mail to the Insurance Chairman.

 Club Sponsored Class Form [Click for PDF]

  1. To ensure coverage for the class members you must complete this form.
  2. List each class member’s name and the insured club they are associated with and send to the GSSDA Insurance Chairman at the address noted above.
  3. Class members are automatically covered as a part of an insured club, with no additional cost with a time limit of 9 months.

Additional Enrollment Form [Click for PDF]

  1. This form must be submitted when a new member(s) joins a club after the Club Roster Enrollment tor the Year form has been submitted.
  2. The form along with the insurance fee for each member listed on the form must be sent to the GSSDA Insurance Chairman at the address noted above.

 Accident Report Form [Click for PDF]

  1. This form must be completed and submitted to the GSSDA Insurance Chairman at the address noted below within 48 hours of an accident.
  2. Upon receipt of this accident report a claim form will be mailed to the club.

 If you have any questions, please contact the GSSDA Insurance Chairman:

Pat Inglis, 1340 Oakengate Drive, Stone Mountain GA 30083. Phone: 404-294-0268 Email: inglisp@bellsouth.net