2015-2016District One Officials’ Playoff Registration Form

SPORT: BASEBALL

Name___________________________________________________

Address__________________________________________________

City___________________________ State___________ Zip_______

Home # ______________________ Cell # _______________________

E-Mail Address ____________________________________________

Graduated From Which High School: _______________________State

Chapter Affiliation: _________________________

Years As PIAA Official: ______

If Employed By A School District, please list: _________________________

Other Conflicts (schools you should NOT be assigned to): _________________

Year you attended the PIAA Convention: (for state playoff consideration) ________

The three steps for consideration to officiate District 1 playoffs:

1 – By returning this completed form you are requesting consideration officiating assignments in postseason play.

2 – Are you in good standing with your PIAA chapter? Y N (circle one)

3 – Please provide other relevant information:

__________________________________________________________________

Please submit this form by March 31, 2016, by one of the following:

Give completed form to Chapter Secretary Jason McDermott, or Email completed form to John Herr at jwherr@verizon.net, or Mail completed form to John Herr, 331 Dean St, West Chester, PA

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