PERSONAL INFO:

First: Last:

Phone: Cell Phone:

Address:

Email:

City:

Age:

State: Zip Code:

Occupation:

LACROSSE INFO:

US Lacrosse Membership#:

Exp Date:

Highest Level of Play Choose High School College Club D3 D2 D1

College:

Position 1: Choose Attack Midfield Defense

Position 2: Choose Attack Midfield Defense

OTHER:

Are you a currently rated umpire? Choose YES NO

Rating: Choose National District Local Apprentice

Are you interested in umpiring intra-league games? Choose YES NO

Are you interested in traveling to tournaments? Choose YES NO

Please select team: Baylax South Baylax

Privacy Policy

Information you provide via this website is completely confidential and is for the sole use of BayLax. We do not rent, sell, or share personal information about you with other people, companies or government agencies.

PLEASE WAIT! There may be a slight delay in processing this form!