Name:___________________________________
Address:_________________________________
_________________________________
Home Phone:_____________________________
Cell Phone:_______________________________
Age: _______ Height:_______ Weight:________
Session Preference: 1 2<
T-Shirt Size: XXL XL L M S
Officiating Experience: _________________
Please read the following:
I hereby release the staff of the Union County Basketball Officials Camp and all liability
from any injuries or illnesses incurred while at the camp. Further, I have no knowledge of
any physical impairment that would be affected by my participation in the camp program as
outlined in this brochure.
Signature: ________________________________
Please enclose your deposit of $99 or full payment of $199. Full
payment is due by June 1, 2009.
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