New Umpire Interest Form

TOURNAMENT
SITE(S) INFO & DIRECTIONS / MAPS:

Go Here!
.

2012 PLAYBALLSERVICES NEW UMPIRE REGISTRATION FORM

IF YOU ARE NEW TO PLAYBALLSERVICES and / or NSA-BPA, Please Complete ALL Requested Information.
And Please Double-check Before Sending, as this is the information that will be used to mail payment checks for
Rec. League (et al.) umpire assignments you will work. NOTE: Field Titles preceded by an “ * “ are REQUIRED!
.

SECTION 1:

Primary Information

*E-mail Address

^*CONFIRM E-Address

^*First Name

*Last Name

^*Mailing Address

^*City

^*State

^*Zip Code

^*#1 AC / Phone

#2 AC / Phone

#3 AC / Phone

SECTION 2:

Background Information & Umpiring Interest -- please be as specific as possible

SECTION 3:

NSA / BPA Registration Interest -- OPTIONAL (If Interest is “Local / Rec. League” only, Skip This Section)

To Umpire NSA and/or BPA Tournaments, before you can step onto a Tournament Field, your NSA/ BPA Sanction Fees MUST BE PAID! When your payment is received, I process your Sanction Approval, and you receive your Sanction # via e-amil. The 2012 Sanction Fee Structure is --
ONE Discipline (Fast-Pitch SB, Slow-pitch SB, OR Baseball) -- $40.00; TWO Disciplines -- $45.00;, or ALL THREE -- $50.00..
Sanction Fee can & should be paid at Clinic on-site registration.. Make Checks Payable to: Barry Parks, UIC
If not attending a clinic, Mail to: Barry Parks, UIC; PlayBallServices; P.O. Box 597; Beecher, IL 60401-0597
(Remember, if NOT attending a Clinic, your NSA / BPA Pay Grade Will Be Affected.)

Check ALL
that Apply

NSA GFP Softball

NSA SlowPitch Softball

BPA Baseball

SECTION 4:

Umpire Training Clinic Sign-up: Clinic Fee -- $20.00; payable at door.

Clinic
Attending

SAT, Feb. 25; LW North HS

SUN, Feb. 26; LW North HS

SUN, Mar. 4; Kankakee

SAT, Mar. 10; Marian Cath. HS

SUN, Mar. 11; Marian Cath. HS

Not Attending 2012 Clinics


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2012 PLAYBALLSERVICES NEW UMPIRE REGISTRATION FORM

*E-mail Address

*Confirm
E-mail

^*First Name

*Last Name

^*Mailing Address

^*City

^*State

^*Zip Code

^*#1 AC / Phone

#2 AC / Phone

#3 AC / Phone

If You Are
a STUDENT:

2012 Disciplines -- Check All That Apply

^*Employment
Status:

. . 8 ....9 ....10 ... 11 ... 12 ... 13 ....14 ... .. 15 .....16 ... ...17+

Are You
Currently A STUDENT?

If YES,
Year in School:

*E-mail Address

^*CONFIRM E-Address

^*First Name

*Last Name

^*Mailing Address

^*City

^*State

^*Zip Code

^*#1 AC / Phone

#2 AC / Phone

#3 AC / Phone

Check ALL
that Apply

2012 PLAYBALLSERVICES NEW UMPIRE REGISTRATION FORM

* E-mail Address

* ConfirmE-mail

*First Name

* Last Name

*Mailing Address

*City

*State

*Zip Code

*#1 AC / Phone

#2 AC / Phone

#3 AC / Phone

If You Are a STUDENT:

2012 Disciplines -- Check All That Apply

*EmploymentStatus:

. . 8 ....9 ....10 ... 11 ... 12 ... 13 ....14 ... .. 15 .....16 ... ...17+

Are You Currently A STUDENT?

If YES, Year in School:

* E-mail Address

* CONFIRM E-Address

*First Name

* Last Name

*Mailing Address

*City

*State

*Zip Code

*#1 AC / Phone

#2 AC / Phone

#3 AC / Phone

Check ALL that Apply

*E-mail Address

*Confirm
E-mail

^*First Name

*Last Name

^*Mailing Address

^*City

^*State

^*Zip Code

^*#1 AC / Phone

If You Are
a STUDENT:

^*Employment
Status:

Are You
Currently A STUDENT?

If YES,
Year in School:

*E-mail Address

^*CONFIRM E-Address

^*First Name

*Last Name

^*Mailing Address

^*City

^*State

^*Zip Code

^*#1 AC / Phone

Check ALL
that Apply