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
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