2010 USSSA Softball Umpire Seminar Registration Form

							                                                     East Coast Umpires Association
                                                     57 North Suffolk Dr.
                                                     Rocky Point, NY 11778
                                                     631-821-8656
                                                     info@eastcoastumpires.com
                                                     www.eastcoastumpires.com


       2010 USSSA Softball Umpire Seminar Registration Form
Please fill out this form completely and return it with your $100.00 non-refundable deposit by
February 10th, 2010. Make checks payable to East Coast Umpires, Inc. or click on the applicable
link below to pay with credit card.
NOTE: When paying online, you do not need to mail in your application. It automatically
registers you for the Seminar.

USSSA Seminar Information
Date: February 28th, 2010
Time: 9:00 AM – 12:00 PM
Location: Baseball Heaven Complex in Yaphank, NY


PLEASE PRINT CLEARLY

Name: _________________________________________________________________

Address: _______________________________________________________________

City: ____________________________ State: __________ Zip Code: _____________

Home Phone: ___________________________________________________________

Work Phone: ___________________________________________________________

Cell Phone: _____________________________________________________________

E-Mail: ________________________________________________________________

Umpiring Experience: _____________________________________________________

_______________________________________________________________________



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