REGISTRATION FORM
Mid-American Umpire Clinic

Name *
First *
Last *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone Number *

###
-
###
-
####
Email *
Age
T-Shirt Size *
Umpiring Experience *
How did you hear about the clinic? *
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 
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]