Channel Coast Officials Association
On-Line Membership Application Form

Directions for filling out the on-line application:
  • Please enter the required information on the fields below.
  • Specify the school nearest to your home for accurate mileage fees computations
  • For all phone numbers, please enter the information using this format: xxx-xxx-xxxx
  • From the list of sports below, select those sports that you would like to get more information regarding membership and training. The per game fees paid for officials for each sport is listed next to each sport.

    • Select Sports
    Please visit the Football site on the previous page Please visit the Volleyball site on the previous page Cross Country/Track & Field ($56-$98)
    Please visit the Basketball site on the previous page Soccer ($48-$93) Water Polo ($48-$101)/Swimming ($54-$151)
    Please visit the Baseball site on the previous page Softball ($51-$60) Wrestling ($20-$98)


    Personal Information
    First Name Middle Name Last Name
    Address
    City State Zip
    Email
      School Nearest Residence
    Home
    (xxx-xxx-xxxx)    		 Work
    (xxx-xxx-xxxx)
    Pager
    (xxx-xxx-xxxx)    		 Cell
    (xxx-xxx-xxxx)
    Fax
    (xxx-xxx-xxxx)
    Have you ever been convicted of a crime?
    If yes,
    please explain


    Experience
    Level Experience
    Level    		 Assignor Phone Number
    (xxx-xxx-xxxx)
    College?
    High School?
    Youth?
    Comments


    Last Unit or Organization Information
    Unit/Organization Name:
    Assignors Name Phone Number
    (xxx-xxx-xxxx)
    Instructors Name Phone Number
    (xxx-xxx-xxxx)
    Reason For Leaving