Umpire Registration Form

First Name(*)

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Surname(*)

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Email(*)

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DOB(*)

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School Year Level(*)

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Mobile Phone(*)

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Team you play in

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Team(s) you coach

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Umpiring for

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Please indicate if you are umpiring for a specific club/team

Do you have 2018 State Membership?

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If not, please register on-line via your club or BNA.

--- UMPIRING ACCREDITATION ---

Theory Exam - Year completed (*)

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Theory Mark %(*)

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Level 1 Course - Year completed(*)

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Badge awarded (if appropriate)

C

B

A

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Year & Venue badge awarded

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--- UMPIRING OPTIONS ---

An umpire availability form will be sent to all registered umpires when fixtures have been finalised.

I am a New Trainee

Umpire the first 2 -3 rounds each week Invalid Input

Consolidating Umpire

Umpire anytime without a mentor Invalid Input

I would like to train for a Badge

Umpire 2 SENIOR games per week Invalid Input

I would like to be an Umpire Trainer for

New Trainees (8.00, 8.40 & 9.20 games)

Badge Training (games between 2.00 - 4.00pm)

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I would like to be an Umpire Tester

Note: must be an experienced badged umpire Invalid Input

--- UMPIRE PAYMENTS ---

To be paid at the end of each term unless alternative arrangements have been organised. All payments will be deposited to your nominated bank account (no cash payments) If your bank details are unchanged from prior years, tick the unchanged box and type "NA" in the bank details boxes.

Bank Details Unchanged

Unchanged Invalid Input

Account Name(*)

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BSB Number(*)

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Account Number(*)

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--- DECLARATION OF HOBBY ---

"For payments in excess of $50, made by Boroondara Netball Association for a service, where an ABN is not provided for taxation purposes. If this form is not signed and an ABN not provided, we are obliged by law to withhold 48.5% for the Tax Office. Please note : It is an offence to make a false or misleading statement".

I hereby declare that the supply (service) is made to the Boroondara Netball Association in my capacity as an individual, and the supply is made in the course of an activity that is a private recreational pursuit or hobby. Therefore, I am not quoting you an ABN. You should not withhold an amount from the payment you make me for the supply. I agree to advise you in writing of circumstances change to the extent that this statement becomes invalid.

(*)

I agree

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Name (Parent/Guardian if under 18)(*)

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Date(*)

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Umpire Registration Form

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