Full Name * Mailing Address: * City: * State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming --Territories-- American Samoa Federated States of Micronesia Guam Midway Islands Puerto Rico U.S. Virgin Islands Zip Code: Home Phone: Work Phone: Cell Phone: Email Address: Age: Height: Weight: Sex: male female T-shirt size (Small, Medium, Large, XL, XXL, or XXXL. There is an extra $3.00 charge for XXL and XXXL that is due at registration.) Small Medium Large X Large XX Large XXX Large Do you need a hotel room? yes no What kind of room do you want (Please see the rates at the top): *Preferred roommate may be requested below for Out of Town ONLY. *Local application fees do not include a Hotel room . Standard Double Private (Additional $77) Roomate Name Experience: What is your highest level of experience? Course Level: Beginner Advanced How do you intend to pay?: if you are using pay pal click on the link on the next page to make your payment Pay Pal Check Requirments: Students are required to provide their own plate gear. If paying by mail, please mail your check to: South Texas Umpire Clinic 9407 Arbois San Antonio, Texas 78254. By typing my name in the signature box I acknowledge that I have read and understand that this form only reserves me a seat in the class. My seat will be confirmed when my deposit check is received within 10 days. Referral: How did you hear about us? Signature: