Mid-American Umpire Clinic
Registration Form
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
###
-
###
-
####
Email
*
Age
Under 18
18-24
25-34
35-44
45-54
55-64
65 or Above
Prefer Not to Answer
T-Shirt Size
*
Select Shirt Size
XXL
XL
L
Umpiring Experience
*
Select Highest Level
College
High School
Youth
How did you hear about the clinic?
*
Select How You Heard About the Clinic
Facebook
Umpire-Empire.com
Other umpire message board
Brochure
Word of Mouth
Other
Do you need a hotel room?
*
Yes
No
Do you have a roommate preference? If so list here:
I have read and understand the contents of this website. I am aware clinic payment is non-refundable.
*
Yes
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