2019-2020 Southern California Soccer Officials Association OC Chapter Application for Membership

Contact Information
Enter your first name (required).
Enter your last name (required).
Enter your mailing address (required).
Enter the city for your mailing address (required).
Enter the state abbreviation where your mailing address is located (required).
Enter the zip code of the mailing address (required).
Enter your mobile phone # (required).
Please enter an alternate phone number in case we can't reach you on your mobile phone.
Please tell us what other phone # you've given us. (For example: WORK, HOME, MESSAGE, ETC.)
Concussion Management
I attest I have watched an acceptable concussion training video within the last 3 years. Acceptable videos are NFHS, USSF, NISOA, AYSO and CDC.
Type AGREE to indicate your consent and agreement to the concussion management requirements stated above.
History
If you answered "YES", then please provide an explanation.
Signature Area
By signing this application, I agree that I am an independent contractor and voluntarily seek to officiate soccer matches assigned by the SCSOA-Unit C (“OCSOA”). I agree to hold OCSOA, its officers, and its assessors and assignors harmless for any harm that occurs to me or my property while performing any task related to officiating soccer matches assigned to me by OCSOA. I agree to pay the fees required to be a member of OCSOA and the assigning fees associated with any officiating assignment that I am offered and accept. I understand that my membership with OCSOA does not guarantee any assignments. I agree to act professionally at all times while performing the tasks of a soccer official. I also understand that continued membership and assignments are conditioned upon my compliance with the ethical and professional standards and bylaws of CIF Southern Section, SCSOA, and OCSOA. I understand that if I do not comply with these standards and/or violate their bylaws that I may be dropped from assignments and/or have my membership terminated. I further attest that I am legally able to work in the United States.
Please type your first and last name to indicate that you are signing this form and certifying that the information you have entered into it is correct and true to the best of your knowledge