EmailMe Form - West Michigan Officials Association Registration

West Michigan Officials Association Registration
Registration form for membership in 2012-2013 sports seasons

Name *

First

Last

MHSAA# *

Check if first year member of WMOA

First year member

Check if information is unchanged from last year

same contact info as last year

Contact Information

Home Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Home Number

###

####

Work Number

###

####

Cell Number

###

####

Email *

enter again to confirm *

Sports Registered to Officiate with MHSAA *

Football

Girls Basketball

Boys Basketball

Status as assigned by MHSAA

# Varsity ratings determines status: 0-5= General, 6-15= Supplemental, 16+= Approved

Football
Status for 2011

General

Supplemental

Approved

Basketball
Status for 2011-12

General

Supplemental

Approved

Football position

Referee

Umpire

Line Judge

Head Linesman

Back Judge

For MHSAA reporting purposes ONLY

Your response is optional

gender (optional)

race (optional)

Registration Status *

Registration Status

ACTIVE MEMBERSHIP --
Includes: patches, directory, and banquet ticket

ASSOCIATE MEMBER ONLY --
Includes directory and banquet ticket
-- Associate membership shall be open to all past members not presently participating in high school athletics who desire mailings and end-of-year banquet ticket

You must also make your membership payment through PayPal or mailing a check.

Your registration is not complete until payment is received. You will receive a confirmation email from the WMOA.

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