WNCOA Application

WNCOA Registration

* I am registering for the following sport(s); the registration fee is given for each sport:

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

home phone number

work phone number

cell phone number

Email Address

You have permission to email me WNCOA information.

* birth date (xx-xx-xxxx)

emergency contact name and number (during game hours)

* WNCOA experience (# of years)

other experience (# years)

if other association, where

* I will be leaving for a game from the following zip code

Explain below any involvement and/or connection with any school we serve (also may use for any other information you feel important):

* Have you ever been convicted of a felony?

Yes

No

First year WNCOA officials must give three references and contact information, including a former coach, school personnel or booking agent.

* Date form submitted

After submitting this form, mail your registration fee(s) to the following address:

Eddy Taylor
WNCOA Secretary/Treasurer
170 Jonestown Rd
Asheville NC 28804

Make check or money order payable to WNCOA and note which sport(s) you are paying the fee(s) for. You will not receive game assignments until the registration fee is paid.

* Indicates Response Required