MIDDLE TENNESSEE BASKETBALL OFFICIALS ASSOCIATION
2008-2009 APPLICATION
(PLEASE TYPE OR PRINT CLEARLY)
NAME: _______________________________________________________________ AGE: ______
ADDRESS: ________________________________________________________________________
CITY: _________________________________________ STATE: ___________ ZIP: ___________
HOME #: ___________________BUSINESS #: _________________PAGER #: _______________
CELL PHONE #: _________________
S. S. #:____________________________________ DATE OF BIRTH: ______________________
OCCUPATION ___________________________________________________________________
WHAT IS YOUR E-MAIL ADDRESS? _____________________________________________
NUMBER OF YEARS YOU HAVE BEEN OFFICIATING FOR MTBOA? ___________
NUMBER OF YEARS YOU HAVE BEEN OFFICIATI NG? __________
YEAR YOU LAST ATTENDED SUMMER CAMP? ___________
AS A REGULAR, DO YOU WANT TO BE PUT ON THE SPECIAL LIST? __________
ALL OFFICIALS MUST PAY 2007-2008 LOCAL ASSOCIATION DUES TO MTBOA NO LATER THAN JUNE 1, 2007 IN ORDER TO AVOID PAYING A LATE FEE. YOU ALSO MUST PAY STATE DUES TO TSSAA EVERY YEAR IN ADDITION TO MTBOA DUES.
MTBOA REGULAR LIST DUES: $80.00
OR
MTBOA RESERVE LIST DUES: $65.00
· AFTER JUNE 1 MTBOA REGULAR OFFICIALS WILL BE REQUIRED TO PAY A LATE FEE OF $25.00 PLUS THE DUES FEE
· YOU WILL BE ASSESSED $10.00 FOR ANY CHECK RETURNED BY YOUR BANK
MAKE ALL CHECKS PAYABLE TO M.T.B.O.A.
MAIL APPLICATION AND CHECK TO: DAVID L. ZEIGLER PHONE: (931)
1046 Tom Osborne Dr. 388-6522
Columbia, TN 38401
SIGNED: _________________________________________ DATED: _____________________
FOR OFFICE USE ONLY:
$____________MTBOA dues received on __________________ by _____________________
Check: # _____________ Cash: _______________
