2024 Registration Form with Payment

CBUA South Bay Registration - 2025

Please register by filling out the form below.
Personal Information
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Alt Phone Number

Area CodePhone Number

Application
Application

Please fill out the information below. Some fields are required.
Number of years Officiating*
Other Associations you work or have worked. If none, please enter "none"*
Enter current or previous Associations
If yes to work(ed) for other Associations, enter the assignor name(s). If none, please enter "none"*
Enter current or previous assignor(s) and phone number(s)
Have you ever been convicted of a crime?*
If yes to conviction, explain here:

Payment
Payments are processed through Stripe. You may pay using any major credit card / debit card.
Umpire Contract*
REGISTRATION OPTIONS:

Option A
- Registration fee of $110.00
- If registration is not completed by 11:59 PM on January 12th, a $20.00 late fee will be added.
- Registration is not refundable
- You are NOT purchasing NASO Group insurance through our plan. The registering member must provide verification of NASO group insurance that is current through June of 2025
Option B
- Registration fee of $110.00
- NASO Group insurance premium of $87.00.
- If registration is not completed by 11:59 PM on January 12th, a $20.00 late fee will be added
- Registration is not refundable
- The insurance fee is not refundable.
- You ARE purchasing NASO Group Insurance through our plan.
Choose Option Below:

Choose Membership Option*

OPTION A: 2025 CBUA Membership WITHOUT CBUA Group Insurance - Must Provide Proof of valid NASO Insurance through June 2025$110.00

* The registering member must provide verification of NASO group insurance that is current through June of 2025 If registration is not completed by 11:59 PM on January 12th, a $20.00 late fee will be added.

OPTION B: 2025 CBUA Membership WITH CBUA SB Group Insurance$197.00

CBUA South Bay MEMBERSHIP and CBUA Group Insurance. You are buying NASO insurance through the CBUA SB Group Plan. * If registration is not completed by 11:59 PM on January 12th, a $20.00 late fee will be added.

Total $0.00

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CBUA South Bay Registration - 2025

Personal Information

Application