I.A.A.B.O.

INTERNATIONAL ASSOCIATION OF APPROVED BASKETBALL OFFICIALS

EASTERN BOARD #8

42 FERLAND DRIVE • DAYVILLE, CT.   06241 • Telephone 860-465-7771; Fax 860-774-7333
Web Site: www.iaabo8.org 

 

 APPLICATION FOR MEMBERSHIP 

                 

I hereby acknowledge that I am 18 years of age and submit this application for membership to the International Association of

Approved Basketball Officials and  Eastern Connecticut District Board #8 of Approved Basketball Officials, Inc. 

I request the opportunity to take the written rules examination on 11/2/09.   It is my understanding that if I pass the written
 examination with a grade of 86% or higher, I will then be eligible to pass a floor examination.  The application fee

of $125.00 is payable in full prior to 11/2/09 with this application & includes clinic fees, test fees, 1st year dues,

roster book,  rulebook, handouts and administrative fees.  ($75.00 refund for failure to pass the written exam.)

 

NAME:___________________________                   DATE OF BIRTH:________________________________

 

RESIDENCE:______________________                  CITY/STATE/ZIP:________________________________

 

SSN:______-______-_____    HOME PHONE:_____________________WORK PHONE:__________________

 

CELL PHONE:_________________PAGER:_______________________OTHER:_______________________

 

EMPLOYER:__________________________ADDRESS:___________________________________________

 

EMAIL ADDRESS:_____________________                          FAX:________________________

 

EXPERIENCE IN YEARS AS:  PLAYER_____       COACH:_____                   OFFICIAL:_____

 

REFERENCES:  List two individuals who are familiar with your background in basketball.  One of these individuals

                                MUST be either a current or former member of IAABO.

 

                                ___________________________ ___________________________________

 

Please sign this application and enclose the fee of $125.00.  Make checks payable to:

 

                                                                                                Eastern Board #8

                                                                                                42 Ferland Drive

                                                                                                Dayville, CT 06241

 

and direct all inquiries to Bob Bernier, Secretary-Treasurer, 42 Ferland Drive, Dayville, CT 06241; 860-465-7771

 

or email iaabo8@snet.net.    VISIT OUR WEB SITE AT iaabo8.org.

 

  

Board #8 member who recommended you for membership:__________________________________________

 

How did you find out about IAABO/Board #8?_____________________________________________________

 

 

 

APPLICANT SIGNATURE:__________________________________            DATE:______________________

 

  

9/15/09