Los Angeles 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
  • Information submitted on this form will be electronically sent to the Unit Secretary: Julie Armendariz at la.unit.secretary@hotmail.com.
Personal Information
First Name Middle Name Last Name
Address
City State Zip
Email
High School Nearest Residence
Phone Numbers (use the defined formats)
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
 

By submitting this form, I agree to the terms and conditions, as stated below:

I understand that I am an Independent Contractor and that I am required by the California Basketball Officials Association, Los Angeles Unit (CBOA-LA) to have Sports Liability Insurance.

I understand that as a member in good financial standing (dues paid in full); the REQUIRED Sports Liability Insurance will be included in the membership.

I understand that as an active member of the CBOA-Los Angeles Unit, in good standing, that I am ONLY guaranteed instructional materials and instruction and that I am NOT guaranteed game assignments.

I understand that the CBOA and/or CBOA-LA is NOT responsible for my health (before, during, or after the basketball season) and it is my responsibility to get a physical or medical evaluation as it relates to the level of physical activity for a high level, fast-paced basketball game.

By checking this box, it indicates that you have read and understood the Terms and Conditions of the Los Angeles Unit set forth above.