Basketball Officials Application

This application is not a contract. It is merely a communication tool to provide MOA with your intent to officiate for the 2003-2004 season, as well as your availability.
Name:
Address:
City:
State:
Zip Code:
Phone (H)
Phone: (W)
Phone: (C)
E-mail Address:
Place of Employment:
Occupation:
What is the earliest time you can officiate:
NOTE: To be eligible to join MOA, all officials must also be registered with the Nebraska Schools Activities Association. Officials must pay the required membership dues $40.00 annually, and shall attend required meetings as determined by MOA. No refunds will be given if an official fails to comply with criteria set by MOA or NSAA. This Application form must be submitted to MOA before June 1. Officials will be allowed to register until October 1 provided the official pays a late registration fee of $10.00 in addition to the regular membership dues. Please keep in mind that MOA intends to have schedules mailed out as soon as possible, consequently the sooner you return your application the better your chances are of receiving games on your available dates.
OFFICIALS EXPERIENCE:
Number of years with MOA:
Number of years with NSAA:
Classification with NSAA:	Registered Approved Certified
Total number of years officiating:
Number of Contests worked Last Year:	Varsity: Junior Varsity:
Name of Partner(s) you would be interested in working with:
Schools, if any, you have a conflict with:
Would you be interested in adding a third official to all varsity games? If so why, if not why not?
What is the smallest game fee you would accept in order to add a third official?

MOA Basketball Officials Application