Kingston Baseball Umpires Association, Inc

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ROOKIE UMPIRE SCHOOL REGISTRATION FORM

* First and Last Name:

* Mailing Address:

* City/Town:

* Zip Code:

* E-mail Address (Must Have One!):

* Cell Phone #:

* Home Phone #:

* Work Phone #:

List any other officiating experience?:

List any members of KBUA you know that can attest to your umpiring ability:

In what school district do you reside?:

* Will you be willing to be fingerprinted and have a physical taken and give proof of same?:

* Falsification of any part of this application is grounds for explusion from this association. I attest that the information is correct to the best of my knowledge and affix my signature in testimony there of::

Questions, Comments Suggestions:

* Date Submitted:

DO NOT WRITE BELOW

Paid: ___ Ck #:______ Rule Book: ____ Case Book ____

Written Test Score:_____ Field Test:_____

* indicates required fields

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ROOKIE UMPIRE SCHOOL REGISTRATION FORM