Please fill in form completely. Thank you.

Name: Date of Birth: / /

Address:

City: Zip:

Phone: Home – ( ) – Work – ( ) – x

Email:

Additional email and/or cell phone: ______

MHSAA ID: Will you be MHSAA registered for 2017-2018? YES NO

Officiating since (year): HVOA Member since (year):

Sports (circle all that apply: Basketball Football Wrestling Baseball Softball

Declaration: “I understand that as a member of the Huron Valley Officials Association I am still maintaining my status as an independent contractor for sports officiating. I also understand that any contests I may officiate as a result of my membership in the Huron Valley Officials Association still represent independent contracts and that I will not be acting as an employee of the Huron Valley Officials Association, in any way.”

Signature (required):

Annual dues are $15.00 for one of the main listed sports or $20.00 for two or more of the main listed sports. To be certain that you will be on the roster submitted to the state for tournament consideration as a Member in Good Standing (MIGS) of the HVOA, we must receive your application and dues by the following dates: Football – Sept. 1, 2017; Wrestling, Basketball – Dec. 1, 2017; Baseball, Softball – April 1, 2018.

You may pay your dues (from a bank account or with a credit card) to our PayPal business account, , and there is also a link on our web site www.huronvalleyofficials.com. You may also send payment via check or money order (no cash, please), payable to Huron Valley Officials Association or “HVOA”, to:

Mike Parsons

HVOA Secretary-Treasurer

2590 Gladstone Ave.

Ann Arbor, MI 48104

Sign and submit this form via U.S. mail or as an email attachment (scan and attach, so signature is included).

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