Membership Renewal by tyndale

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									                 THE OHIO COLLEGIATE SOCCER OFFICIALS ASSOCIATION
                                       Proudly Serving Ohio Collegiate Soccer Since 1963

                          OCSOA MEMBERSHIP RENEWAL FORM FOR 2009
To renew membership in OCSOA & NISOA for 2009, please provide the information requested below, and submit a check in the
appropriate amount (payable to OCSOA) postmarked no later then December 1, 2008. A $25 late fee will be assessed by
OCSOA to members renewing between December 2-15, 2008. NOTE: Members who fail to complete membership renewal by
December 15, 2008 will not be renewed with OCSOA or NIOSA. THERE WILL BE NO EXCEPTIONS.

Name: ___________________________________________________________________________________________

Address: _______________________________ City: ______________________ State: _________ Zip: _____________

Home Phone: _________________ Work Phone: __________________ Cell Phone: ______________________

E-mail Address: ______________________________________________________________________________

Please choose a permanent region for voting purposes: ( ) Cincinnati       ( ) Columbus     ( ) Dayton       ( ) Northwest

Please complete the spaces on the right side with the correct dollar amounts:
A1.     Full Membership in OCSOA and NISOA: $30 for OCSOA + $80 for NISOA = $110 Total:                              _________
        Rights include providing availability for game assignments, voting, and holding office.
        Payment of 2009 OCSOA/NISOA dues does not guarantee receiving game assignments in 2009.
        Game assignments are based on availability, travel limits, ability, fitness and other factors.

A2.     Associate Membership in OCSOA and NISOA: $20 for OCSOA + $50 for NISOA = $70 Total:                          _________
        Open to any person interested in the sport of soccer and the Association. No right to vote, hold office
        or officiate games under the aegis of the Association.

A3.     Inactive Membership in OCSOA and NISOA: $20 for OCSOA + $40 for NISOA = $60 Total:                           ________
        Granted to an active member for a period not to exceed one (1) year. No right to vote, hold office
        or officiate games under the aegis of the Association.

A4.     Dual Membership in OCSOA: $30 for OCSOA (Pay NISOA dues in Local Chapter)                                    _________
        Rights include providing availability for game assignments. No right to vote or hold office.

A5.     Affiliate Membership in OCSOA and NISOA: $20 for OCSOA + Assessor fee of $45, $55, or $65                    _________
        Persons serving the Association as an Assessor only (not a full, assoc. or inactive member).

A6.     Associate Membership in OCSOA only: $20. Open to any person interested in the sport of soccer                _________
        and the Association. No right to vote, hold office or officiate games under the aegis of the Association.

B.      Game Assignment Fee for OCSOA: $2 for each OCSOA game assigned in 2008:                                      _________
        Count only games assigned by OCSOA Assignor, Roger Phipps/Rizal Milliken, INCLUDING turnbacks

C.      Penalty Fee: $25 (Renewing between December 2-15, 2008)                                                      _________

D.      TOTAL $ AMOUNT DUE: A + B (+ C, as necessary) =                                                              __________

        I do not wish to renew my membership in OCSOA/NISOA for 2009, but attached is payment                        __________
        for my Game Assignment Fees from the 2008 season.

                  Please mail this Membership Form and your check (postmarked) by December 1st to:
                                          Michael Kinder, OCSOA Treasurer
                                      3343 Mill Run Drive, Beavercreek, OH 45432

								
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