MEMBERSHIP FORM
(Please fill out completely)
Name: ____________________________________
Address:
___________________________________________________________
City: ___________________________________ ST ________ Zip ___________
Work Phone (___)__________________
IHSA Officials # _______________
Cell Phone (___) __________________ E-mail ________________________
TYPE OF MEMBERSHIP (Check
One):
Executive($35) ______ Associate($30) ______
IHSA Classification (Check
One): Registered ____ Recognized ____ Certified ____
IBOA Website www.ilboa.net
=========================================================================
I acknowledge that, as a
licensed official, I am acting as an independent contractor with respect to the
schools that I contract games with. Although a member of the Illini Basketball Officials Association (IBOA), I am not
considered an “employee” of the IBOA. I shall be solely responsible for, and
will not hold the IBOA liable for, any medical, insurance or liability expenses
that I may incur, as well as any liabilities concerning federal, state, or Social
Security income taxes that may result from my officiating.
Signed
___________________________________
RETURN FORM WITH YOUR CHECK
TO: Rod Stoll
(CHECK PAYABLE TO IBOA) Treasurer
– IBOA