ODUA Registration Form

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Please complete all sections of this form to ensure your registration is received and processed.

Email *

First Name *

Last Name *

Spouse's Name

Street Address (1234 N. Orange St.) *

City *

State (VA) *

ZIP Code (5-digit) *

Mobile Phone *

Other Phone (if Cell is not available at home/work)

Date of Birth *

YYYY

Email Address used for Arbiter Registration (only if different from email collected above)

How did you hear about ODUA? If someone referred you to ODUA, who was that person? *

Umpire Experience: Number of years umpiring baseball? *

Number of years umpiring HS Varsity baseball? *

Highest level of baseball you have umpired? *

Youth / Travel Baseball

High School

JuCo / NAIA

NCAA

Other:

Level of amateur baseball to which you aspire? *

Youth

High School Varsity

Collegiate

Other:

Please list any possible conflicts of interest for assignments *

If you are transferring from another umpire group, please list the name and point of contact for that group. *

Current ODUA Member

New Umpire - never have been in any other group

Other:

Contractor Agreement: I agree to serve as an independent contractor with respect to any assignment that I accept. Further, I agree to hold ODUA,the ODUA Board of Directors, and the Commissioner harmless and free from any and all liability for injury and damage sustained as a result of my assignments. I agree that I will attend the State officiating baseball clinic, work scrimmages, and take written examinations as required. I understand that all members of ODUA are independent contractors and accept assignments on their own volition. I understand that registration does not carry any obligation on the part of the Commissioner for a specific number of assignments. Any assignment that I receive is subject to cancellation by the Commissioner if he, or the majority of the ODUA Board of Directors, deems such cancellation to be in the best interest of ODUA. Further, I agree to hold the Commissioner and/or the ODUA Board of Directors, harmless with all respect to game assignments. *

I AGREE

I DO NOT AGREE

Compliance with Code of Virginia §22.1-296.1: I, the undersigned, under penalty of perjury, certify that I have never been convicted of a felony or any offense involving the sexual molestation or physical or sexual abuse or rape of a minor. *

I have read and verify that I comply with the COMPLIANCE WITH CODE OF VIRGINIA §22.1-296.1.

I cannot comply with Code of Virginia §22.1-296.1

Signature: By typing your full name and submitting this form, you are agreeing that the answers you are providing are correct and true. *

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