LAKE CUMBERLAND SOFTBALL UMPIRES ASSOCIATION

Registration Form

(Please print LEGIBLY)

Name__________________________________________________ Social Security #_________________________________

Complete Address_______________________________________________________________________________________

                             __________________________________________________________________________________

Home Phone____________________________   Work Phone_____________________________ (extension)______________

Cell Phone__________________________________________  Other Phone________________________________________

E-mail Address (print LEGIBLY)_____________________________________________________________________________

            Umpire Uniform # ________________________________________  (if not previously assigned, list several to consider)

Print out form and return with $70 fee ($40 for 1st year) to: 

John E. Drake,Supervisor,  110 Man-O-War Drive, Danville, KY  40422

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