| Name: |
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| Date of Birth: |
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| Home Phone: |
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| Email Address: |
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| Parent's Name(s): |
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| Parent's Phone Number: |
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| School Attending in Fall 2015 and Grade Level: |
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Years experience umpiring baseball:
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| Where have you umpired? |
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| Years experience playing baseball: |
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| Where have you played baseball? |
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| If playing baseball in 2015, what level and where? |
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|
..
|
