Umpire Membership Information
Last Name *
Last Name
Your answer
First Name *
First Name
Your answer
Address *
Your answer
City *
i.e. Saint Louis
Your answer
State *
i.e. MO
Your answer
Zip Code *
i.e. 63123
Your answer
Social Security Number (xxx-xx-xxxx)
Your answer
Using the map below, in which district do you reside? *
District 7
Main Phone Number (XXX-XXX-XXXX) *
Your answer
Cell Number (XXX-XXX-XXXX) *
even if it's the same as the "Main Phone #"
Your answer
Work Phone (XXX-XXX-XXXX)
not likely to get a call here, but it could be a softball emergency...
Your answer
Email - the one you check most often *
your home email
Your answer
Work Email *
a back up, we like to keep everyone informed
Your answer
Your Gender *
please pick only one
Date of Birth (xx/xx/xxxx) *
need the month, day and year, please
Your answer
This will be my _____ year registered with ASA or USA Softball? *
use a number
Your answer
Do you umpire Slow Pitch or Fast Pitch or Both? *
read all options before choosing
Are You Registered In Another USA Softball Association? *
If registered in another USA Local - where?
Your answer
Last year you attended an ASA/USA National School? *
Attended Advanced Camp? *
Year of Advanced Camp
Your answer
Worked a National Championship? *
How many National Championships have you umpired?
Your answer
Year of last National Championship?
Your answer
Level of play for last National Championship
Choose all that apply
Are you a member of the National Indicator Fraternity? *
Do You Participate in Medals Program? *
Medals Program Level?
Are you an "Elite" umpire? *
Are you certified by the WBSC for international competition? *
I understand I am an Independent Contractor and not an employee of STLMSUA, St. Louis Metro ASA, ASA/USA Softball or any other variation of names representing USA Softball. *
Registration Fee BEFORE Feb 18 *
Registration Fee after Feb 18 *
I will be attending the Metro clinic..... *
Total amount due at this time - A $25.00 fee will be assessed for each check returned by the bank for insufficient funds. *
My total Payment is......
Your answer
Optional Questions
These answers will help us get to know you and refine our communications.
NEW UMPIRES are strongly encouraged to complete this section.
What Are Your Personal Goals In Umpiring? There are many reasons people choose to umpire, whether it’s to stay close to the game, umpire more/less each week, earn some extra income, improve their skill level, or something totally different; umpires usually have some kind of goal in mind. What is yours? Let us know, and maybe we can help you reach them!!
Your answer
Your answer
Spouses Name
Your answer
Your answer
Childrens Name(s)
Your answer
Your answer
Work any other sports?
Choose all that apply
Use Facebook?
Use phone to Text?
Use Twitter?
Use a Smartphone?
Use GPS?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms