5071 WEST H AVENUE | KALAMAZOO, MI 49009 | 269.381.6630 Home Products Forms About Us Contact Us Authorization Release Forms Guarantee Trust Berkley CONTACT US Address 5071 WEST H AVENUE | KALAMAZOO, MI 49009 Call Now 269.381.6630 Mail 1stAgency@1stAgency.com EXPLORE OUR SITE Home About Us Contact Us © Gallagher 1999 - 2021. Legal Information Terms of Use Privacy Policy Compensation Disclosure

5071 WEST H AVENUE | KALAMAZOO, MI 49009 | 269.381.6630 Home Products Forms About Us Contact Us } Player Census Form Our office requires information regarding participant numbers for the coming year at your university or college. Complete the form below with the projected number of participants and include under additions/deletions any sports being added or dropped for the coming year. Please return to First Agency, Inc., address above, by the 1st day of March. Sport Baseball Basketball Bowling Cheerleaders Competitive Cheer and Stunt Cross-Country Dance E-Sports Equestrian Fencing Field Hockey Football (Fall) Football (Spring) Golf Gymnastics Ice Hockey Lacrosse Riflery Rodeo Rowing Crew Rugby Sailing Skiing Soccer Softball Student Managers / Trainers Swimming Diving Tennis Track and Field (Outdoor) Track and Field (Indoor) Volleyball Water Polo Wrestling Others: Additions For Coming Year: Deletions For Coming Year: Total: Female Male Total INSTITUTION INFORMATION Name of Institution: Address: City: State Zip Code: Telephone Number Fax Number: INFORMATION PROVIDED BY Info Name: Info Title: Info School Year: CONTACT US Address 5071 WEST H AVENUE | KALAMAZOO, MI 49009 Call Now 269.381.6630 Mail 1stAgency@1stAgency.com EXPLORE OUR SITE Home About Us Contact Us © Gallagher 1999 - 2021. Legal Information Terms of Use Privacy Policy Compensation Disclosure

5071 WEST H AVENUE | KALAMAZOO, MI 49009 | 269.381.6630 Home Products Forms About Us Contact Us Why Choose Coverage through First Agency ? Personal Visit: Each year an agent from First Agency meets personally with your institution to review the coverage. This allows for the establishment of a long-term relationship. Written Report: Each year First Agency provides a written report that includes claim payment information as well as information on pending claims. Renewal Rates: Renewal rates for all future years are based on your institution's medical expense experience. Claims Processing: All claims are managed through First Agency's office in Kalamazoo, MI. Experience: First Agency has been providing student and athletic accident coverage to educational institutions since 1959. CONTACT US Address 5071 WEST H AVENUE | KALAMAZOO, MI 49009 Call Now 269.381.6630 Mail 1stAgency@1stAgency.com EXPLORE OUR SITE Home About Us Contact Us © Gallagher 1999 - 2021. Legal Information Terms of Use Privacy Policy Compensation Disclosure