Interest and Registration Form
Minnesota Lacrosse Umpires Association (MLUA)
2019 UMPIRE TRAINING APPLICATION

New Adult (1st year) umpires and all Youth (both 1st year & returning) umpires will use this form to sign up for Girls Lacrosse Umpire Training for the upcoming 2019 spring season.

For youth-only umpires, the training cost is $50 and includes classroom & field session training by our highest ranked officials, a yellow referee T-shirt which you will wear for your youth games, and other required equipment (warning cards, yellow flag, whistle, pencil, scorecard). If you are a returning youth umpire and have all the supplies already, the training cost is $30.

For new adult umpires working high school games, the training cost plus your annual dues are $90 and includes everything listed above.

Send a check made out to "MLUA" for either $30, $50 or $90 to:

Fred Edstrom, MLUA Treasurer
3309 Highlands Road
Brooklyn Park, MN 55443

Please have your US Lacrosse number ready for fill-in on this form. Thank you and Welcome!

Email address *
Contact Information
First Name *
Your answer
Last Name *
Your answer
Address: *
Your answer
City/Town: *
Your answer
State: *
Zip Code: *
Your answer
Phone Number: *
Your answer
Which session are you registering for: *
Have you officiated girl's lacrosse before: *
If yes, how many seasons?
Your answer
If yes, on average how many games per season have you officiated?
Your answer
What level of girl's lacrosse have you officiated (please select highest level): *
To officiate youth lacrosse you must be in 9th grade or above. Please select which year you will finish in 2019: *
Please provide your date of birth (For youth officials, this is to validate that you are at least 2 years older than the level of play officiating.): *
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If you are under 18 years old, please provide an emergency contact:
Name:
Your answer
Primary Phone (Home/Cell):
Your answer
What are the best ways to contact you for game assignments, training, special events or other MLUA related activities? *
Required
When would you like to begin officiating (youth spring season begins May): *
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Do or have you played or coached lacrosse? *
Required
What is your US Lacrosse Membership Number (if you don't know, type that below and then come back to the form to update it, be sure to send a copy of this registration to yourself): *
Your answer
If you have played/coached lacrosse, for which team or community did you participate?
Your answer
Does your email address on your US Lacrosse account match the email you provided above?
Do you officiate other sports, if so which sports and for how long:
Your answer
Are you willing to travel outside the area you reside to officiate, possibly 15 - 20 miles or more? (If you are an adult official some travel outside your area is expected.)
Did someone refer you to or encourage you to become an official (please list name below):
Your answer
NOTE: We use ArbiterSports to schedule games online. Setup information will be discussed at the classroom training session.
Please provide any additional information you would like us to know prior to your training:
Your answer
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