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California Softball Officials Association - Los Angeles
CALIFORNIA SOFTBALL OFFICIALS ASSOCIATION-LOS ANGELES UNIT
APPLICATION FOR MEMBERSHIP
AS A MEMBER OF CALIFORNIA SOFTBALL OFFICIALS ASSOCIATION-LOS ANGELES UNIT YOU ARE NOT GUARANTEED GAMES.
Please Type or Print
Name: _______________________________________
Address: ______________________________________
Work Number: ( )_____________________________
Fax Number: ( )______________________________
Emergency Number: ( )_________________________
Date of Birth: Month_____ Day _____ Year _____
If yes, please explain: _____________________________
Email:________________________________________
City:_________________________ Zip Code:_________
Home Number: ( ) ____________________________
Cell Number: ( ) ______________________________
Name:________________________________________
Have you ever been convicted of a crime? Yes____ No _____
____________________________________________
My Experience
Years with CSOA-LA Unit: _______________ Years with Other CSOA Unit _______________
Years of Experience: Youth __________ Adult __________ High School __________ College __________
I am Working: ASA _____ College _____ Recreation _____
My Other Assignor: _________________________ Phone Number: _____________ Unit/Sport ________________
My Other Assignor: _________________________ Phone Number: _____________ Unit/Sport ________________
My Other Assignor: _________________________ Phone Number: _____________ Unit/Sport ________________
Last Softball Unit or Organization you were a member of: ________________________________________________
Reason for Leaving: _________________________________________________________________________
Assignor: ____________________________________ Phone Number: (______)_________________________
Instructor: ___________________________________ Phone Number: (______)_________________________
Do Not write in this Box
Insurance Carrier: ________________________________________ Date Expire: ______________ Fee: ________
Amount Paid: ______ Check #:_______ Cash: ________ Date: _______ Recieved by: _________________________
This form must be completed and returned with the Umpire Contract form to: CSOA-LA, Beverly Myers, 5616 S. Deane Ave., Los Angeles, CA 90043
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