Name Spouse Date

Address City, State & Zip

Home Phone Work Phone Cell Phone

Job Title Years with current employer

Email Address Fax Number

BASEBALL: Spring Summer SOFTBALL: Summer Fall

This is my year as a member of the GSLAU - Assigned Shirt No.

Social Security Number (required) State Registration No.

What time can you leave work? AM PM

Nearest MAJOR INTERSECTION from where you leave for a game

NEW MEMBERS ONLY

Years experience umpiring Baseball Softball Both

How did you hear about us? Ad Member School or Other

Do you need equipment? Yes No

Are you currently registered with the MSHSAA? Yes No
If so, what is your registration number?

Any question about this application call Mike Behnen 314-650-6935 (Cellular)
Remit $30.00 dues after submitting this application to the address above.
New applicants add a one-time $15.00 initiation fee.

Any further dues will be deducted from spring game fees.
In making this application, I agree to be bound by the By-Laws and
Rules & Regulations of the Greater St. Louis Association of Umpires.