CWLOA Registration - CGLA
Junior Officials Registration Complete this form IF you are currently enrolled in high school (Note: 8th graders with
GPA of 3.75 or higher may also use this form). Adults, please do not use this form Instead, go to www.cwloa.com and select ADULT OFFICIALS REGISTRATION FORM.
Today's Date *
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First Name *
Your answer
Last Name *
Your answer
Address (Street, City, State, ZipCode) *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Male or Female (M or F) *
School Attending *
Your answer
Current Grade
Column 1
8th
9th
10th
11th
12th
Date of Birth *
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** Personal Unique email
This must be your own (not parents) email; and the same one that you registered with US Lacrosse.
Personal Unique email *
Your answer
Parent's email *
Your answer
Parents Cell Phone Number *
Your answer
US Lacrosse Membership Number
You must have a current membership with US Lacrosse in order to officiate. Go to uslacrosse.org/membership to sign up.
US Lacrosse Membership Number *
Your answer
Lacrosse playing experience *
Lacrosse officiating experience *
Shirt Size (If you already own a short-sleeved officiating shirt, skip this)
After completing this form, please PRINT Page 1only and MAIL WITH PAYMENT to Allison Bailey. Make checks payable to CWLOA for the correct total: Annual registration only: $25 Registration + Shirt ($18)=$43

Mail to: Allison Bailey, CWLOA Treasurer, 4989 W 118th Court, Westminster, CO 80031
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