MOA Application Form

Margarita Officials Association

555 W. Country Club Lane #C138, Escondido CA 92026

Membership Application

Last First

Name: Name:

SSN:

Mailing Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell:

Date of Birth:

Place of Birth:

Email:

Sport(s) you wish to officiate? Softball (CIF) ___ Softball (FP) ___ Softball (SP) ___Volleyball ___
Do you have officiating experience? Yes ___ No ___. If yes, indicate below which sport(s), what level, and years of experience. If more space is needed please use the back of this form. (No previous officiating experience required)___________________________________________________________________________________

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Are you now, or have you ever been, a member of an officials association or organization? Yes ___ No ___. If Yes, list below the name of the association(s) or organization(s) and periods of membership. If more space is needed please use the back of this form. __________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

Do you have playing experience? Yes ___ No ___. If yes, indicate below which sport(s), what level, and years of experience. If more space is needed please use the back of this form. __________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

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REFERRED BY: _______________________ ____________________________________________MMember’s Signature Date
For Association Use Only

Date: ____________________

Liability Insurance: Carrier _____________________________________Expiration Date ___________________

Sport Fees Paid: FP Softball _____ SP Softball ______ VB ______

Member-at-Large:____________________________________________________________________________

Once you have printed the MOA application please mail it along with your Annual Dues $40.00 and $15.00 for your first Sport Fee and $10.00 for additional Sports you wish to officiate. Please send check or money order made out to Margarita Officials Association or MOA and send to this address:

Margarita Officials Association or MOA
555 W. Country Club Lane #C138
Escondido, CA. 92026

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