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Membership Application
El Paso Volleyball Officials Association
Please Choose one
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NEW MEMBER - New members to this sports
ANNUAL RENEWAL - Returning members
REINSTATEMENT - Returning members (No dues paid last year)
Full Name
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First
Last
Date of
Birth
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Mailing Address
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Street Address
City
State / Province / Region
Postal / Zip Code
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New Zealand
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Papua New Guinea
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Algeria
Angola
Benin
Botswana
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Burundi
Cameroon
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Central African Republic
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Comoros
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Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
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Gabon
Gambia
Ghana
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Guinea
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Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
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Malawi
Mali
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Mauritius
Morocco
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Namibia
Niger
Nigeria
Rwanda
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Senegal
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South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
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Country / Region
Cell Phone
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Work Phone
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Email
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SS# (last four digits)
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Experience:
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High Level Officiated
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NCAA
USA Volleyball
HS Varsity
HS JV/Freshman
Recreational
City League
Youth League
Other
None
No. of years officiating volleyball
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15+ Years
13-14 Years
11-12 Years
9-10 Years
7-8 Years
5-6 Years
3-4 Years
1-2 Years
None
No. of years Playing Experience
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15+ Years
13-14 Years
11-12 Years
9-10 Years
7-8 Years
5-6 Years
3-4 Years
1-2 Years
None
High Level Played
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NCAA
USA Volleyball
HS Varsity
HS JV/Freshman
Recreational
City League
Youth League
Other
None
No. of years officiating other sports
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(sport/yrs)
Is this your first chapter affiliation?
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Yes
No
List any other chapter memberships:
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Member Controlled Schedules/No Guarantee of Assignments
Member acknowledges and agrees that Executive Board’s ability to assign Member to contests is dependent on Member keeping EPVOA informed and updated on Member’s availability for such assignments; that Member is free to define how much, how little and when Member will make him or herself available for game assignments. Member also understands and agrees that the EPVOA does not guarantee Member any specific game assignment any number of game assignments or any game whatsoever.
Please list any conflict of interest with any school or additional comments concerning your availablity:
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Indicate above the name of the school of any family members, school employees, alumni, and
Athletic Sports Program volunteers to the assigning secretary. This information is used to manage
your assignments during the volleyball season.
Independent Contractor Status Compliance with Law
Member acknowledges that Member’s relationship with Customers is that of an independent contractor and Member is not providing services as an employee of the Customer. Member also acknowledges that Member’s relationship with the Executive Board is that of a voting Member eligible to use the service provided by the Executive Board (per the EPVOA Policies and Procedures) in a manner consistent with its Constitution, Bylaws, Policies and Procedures. Member has no authority to any way bind, act on behalf or, or speak for the Executive Board or for any Customer. Further, Member represents that Member is in compliance with all applicable laws regarding the provision of services in Texas State as an independent contractor. Any and all member insurance coverage is subject only to UIL/EPVOA sanctioned regular season and postseason events.
Physical Condition Statement
I am in good physical condition and have no medical condition that precludes me from officiating volleyball. I agree to abide by Constitution and By Laws of this Executive Board.
Waiver Indemnification
Member hereby irrevocably waives his/her right to bring claim against the EPVOA, its Assignors, Executive Board Member, Members and any EPVOA affiliate, to recover damages for personal injury to Member’s property or any consequential or special damage of any kind resulting from provision of officiating service pursuant to this agreement including any claim for loss of income from such injury or damage regardless of the legal theory under which such claim is brought. Member also agrees to indemnify, defend and hold the EPVOA harmless from any claim brought by a third party against the EPVOA, Assignors, Executive Board Member, Members and affiliates, that is based on Member’s provision of service pursuant to this agreement regardless of the legal theory under which such claim is brought.
Term and Termination
EPVOA has the right to refuse or reject any registration form without cause or explanation. Receipt of this form constitutes acceptance, unless otherwise notified.
Governing Law/Jurisdiction
This Agreement shall be interpreted, constructed, governed by and enforced in accordance with the laws of the State of Texas. Any litigation or other court proceeding with respect to any matter arising from this Agreement shall be conducted in the state or federal courts of El Paso County in the state of Texas.
Members may execute this Agreement and the undersigned hereby agree to comply with the constitution and bylaws of the El Paso Volleyball Officials Association (EPVOA) / UIL.
Signature
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Clear
Date
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