Welcome the the Online Version of the Annual WCOA Membership Registration. The Form that follows is designed to make your WCOA registration quick and easy. Please fill out all the fields below, select your sports, payment method, sign, and submit. Your submission will be emailed to the WCOA Treasurer and to yourself.

Important Note: After you have submitted this form, YOU MUST MAKE YOUR PAYMENT SEPERATELY, using the method of payment you chose on the form.

WCOA Annual Membership Registration Form

Section

Date *

Early Bird Deadline – ( – $10 )

Tackle Football Only

Late Payment Date – (+ $20)

Football

Late Payment Date – (+ $20)

Basketball

Section

Registration Type *

Renewal

New

Name of Referring Member (if applicable)

Section

Name *

Name

Last

Last

First

First

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Address

Phone *

Section

Email *

Social Security Number *

Date of Birth *

Race (FHSAA Required) * Select OneAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhite

Gender (FHSAA Required) * Select OneMaleFemale

Primary Association (if not WCOA

Section

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Fines                                                           BB                         FB

Decline/Accept by Passed ——- $10                    $20

Cancel Within 24 Hours ——— ½ Game Fee    ½ Game Fee

No Show ———————— Game Fee and Suspension

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Sport Selections

Tackle Football

Tackle Football

Flag Football

Flag Football

Football ECO

Football ECO

Basketball

Basketball

Basketball ECO

Basketball ECO

Fee Summary

Submission Discount

Date Discount / Penalty

Selection Fees

Sports Selection Fees

Board Member Discount

Board Member Discount

Student Discount

Student Discount

Total Payment Due

Total Payment Due

Bank Information for Direct Deposit New Members: Please provide your Bank Information below. Renewing Members: Please provide if your information has changed or not currently on file with the Treasurer.

Routing #

Account #

Section

Choose a Payment Method *

Zelle (727-580-8035)

Venmo (727-580-8035)

Check

Money Order

Board Member

High School Student

Payment Instructions Bring Check/Money Order to the next WCOA Meeting or Mail To: ———————————————- West Coast Officials Association, Inc. Attn: Mark Marino, Treasurer 10604 Orange Grove Dr. Tampa, FL 3361

Attention Members! Selecting the Zelle, Venmo, or Cash App Option from the list above, DOES NOT automatically send payment. Once you have submitted this form, remember to send your payment separately via the App you selected.

Board Position

Executive Board

Sports Rep – Football

Sports Rep – Basketball

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Section

Member Certification

<h3>I will notify the assignment officer of any changes in my availability prior to assignments being distributed and will keep my Arbiter availability up to date. I agree to the deduction of all fines from any game fees and that fines may be reviewed by the Sports Committee. I will read and abide by the Bylaws of this association.</h3>

Date *

Member Signature (Type Your Full Name) *

Clear

Submit

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