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Southern Independent Conference Officials Association      

Southern Independant Officials Alliance
 

Application to Join

Please do not complete this form unless you are prepaired to pay the fee at this time.
Forms submitted without accompaning payment will be rejected
.
 
   
 

Application Information

Check all that apply: Returning Member New Member Transferring Official Student Official ECO Only

The FHSAA allows officials to belong to a maximum of two officials associations. Will SICOA be your primary or secondary FHSAA association in 2016? Primary Secondary

If you answered secondary, please list below the name of the associations
that you plan on listing as primary this season:


Personal Information

First Name:

Last Name:

Address:

(123 Main Street)

City:

State:

Zip:

Email Address:

(youraddress@yourdomain.com)

Phone Number:

(xxx-xxx-xxxx)

Cellular Number:

(xxx-xxx-xxxx)

Date of Birth:

, , (xxxx)

Last 6 digits of your Social Security number: XXX- -


Past Experience

Level:

Position:

Years of Exp.

Flag Football

Youth Football

Jr. High/Middle Sch.

Junior Varsity HS

Varsity HS

Minor League

Collegiate

Indoor

I have no formal experience.


Legal Record (you must answer a, b, and c not answering all questions will disqualify application)

a) Have you ever been arrested for a felony?
Yes* No

*If "yes" please give details:

b) Have you completed and passed a fingerprinting and Level 2 Background Check in accordance with the requirements set forth by the Florida Legislature?
Yes No

*If "yes" please tell us what school district and year:

c) Have you ever had your membership with any other officials association canceled, suspended or revoked?
Yes* No

*If "yes" please give details:


Digital Signature

Please check this box to certify your electronic signature and agree to the statement below.*
*By completing this registration form and joining SICOA as a contest official, I understand that I am eligible to officiate at the appropriate level of competition indicated by my experience, but fully understand that there are no assurances of any game assignments. Further, I understand that my membership is based on my successful completion and passing of an FBI fingerprinting and Level 2 Background Check in accordance with the Jessica Lunsford Act that was put into law by the Florida Legislature. I also understand that I must be a member of the Florida High School Athletic Association, and take the 2016 FHSAA on-line rules examination. My membership with SICOA does not create an employment contract as I am an independent contractor and thus responsible solely for all expenses, fees and taxes. I will abide by all rules and policies of the association. I attest all information provided is truthful and accurate.
SICOA membership runs from January 1st to December 31st of the current calendar year with an annual non-refundable fee of $55.00, which must be submitted with this form. Please note: a late fee of $10 is assed for applications after July 1st. Upon sending this application you will be taken to the payment page.

THIS CERTIFICATION CONSTITUTES MY ELECTRONIC SIGNATURE.

Enter Validation code here:

 
 
 
       
 

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