Mid-American Umpire Clinic Registration Form
Name *
First *
Last *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
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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