APPLICATION TO: EASTERN OFFICIALS ASSOCIATION 3000 GRAHAM DRIVE, KINSTON, NC 28504

NAME ____________________________________________________________ SPOUSE _____________________

(LAST) (FIRST) (MI)* Required (FIRST)

ADDRESS _____________________________________________ CITY/ZIP ______________________________

SOCIAL SECURITY # ________________________________________ YEARS EXPERIENCE _________________

PHONES: AREA CODE (_____________) HOME _______________________________________________

CELL ______________________________________ WORK ____________________________ EXT (_______)

E-MAIL ADDRESS (REQUIRED, PRINT VERY CLEARLY) ___________________________________________________

BOOKING FEE (NON REFUNDABLE) (Due with Application) BEFORE AUG 31 $ 85.00 ** SEPT - (IF NEEDED) $ 110.00

** With the economy slow and some people out of work, we will include the Private Schools & some Middle Schools this year only.

MAKE CHECKS PAYABLE: TOMMY MATTOCKS

EMPLOYER _______________________________________________ POSITION _________________________

BIRTH DATE _____/_____/_____ RACE ____________ H. SCHOOL ATTENDED ___________________

LIST EXPERIENCE (USE BACK IF NEC) _____________________________________________________________________

LIST CLOSED DATES (USE BACK IF NEC)_______________________________________________________________

LIST ALL BOOKING AGENTS IN THE ORDER OF GAME ACCEPTANCE: ( INCLUDE EOA )

(1)_________________________ (2)__________________________(3) _________________________(4)___________

DECLARATION:

I UNDERSTAND THAT REGISTERING WITH THE EASTERN OFFICIALS ASSOCIATION IS FOR ONE SEASON AND DOES NOT

GUARANTEE ME ANY NUMBER OF GAMES. I ALSO UNDERSTAND I AM AN INDEPENDENT CONTRACTOR AND IN ACCEPTING AN

ASSIGNMENT, I AGREE NOT TO HOLD THE EASTERN OFFICIALS ASSOCIATION OR TOMMY MATTOCKS LIABLE FOR ANY INJURY

I MAY RECEIVE INCLUDING TRAVEL TO AND FROM THE GAME AS WELL AS THE GAME ITSELF. I AM AWARE THE BOOKING

OFFICE MAY PULL ME OFF A GAME AT ANY TIME IT FEELS IS IN THE BEST INTEREST OF THE ASSOCIATION OR THE SCHOOLS

INVOLVED. I ALSO UNDERSTAND THE BOOKING FEE IS NON REFUNDABLE..

I FURTHER AGREE TO KEEP THE BOOKING OFFICE POSTED IN WRITING OF MY CLOSED DATES AND IF I FAIL TO DO

SO, I MUST MAKE EVERY EFFORT TO FULFILL AN ASSIGNMENT THAT I RECEIVE SUBJECT TO A "REPLACEMENT FEE" OF $ 25.

I AGREE TO ACCEPT AN ASSIGNMENT WITH ANY OFFICIAL REGISTERED WITH THE ASSOCIATION AND GO TO ANY SCHOOL

THAT I AM ASSIGNED. I AM ALSO AWARE AT TOURNAMENT TIME, THE POLICY IS I ACCEPT ALL TOURNAMENT GAMES

OR NO TOURNAMENT GAMES FOR DATES WHICH I HAVE NOT PREVIOUSLY CLOSED WITH THE BOOKING OFFICE.

BY SIGNING BELOW, I CERTIFY THAT I HAVE NOT BEEN CONVICTED OF A FELONY. I FURTHER CERTIFY

THAT IF I AM CHARGED WITH A FELONY, I WILL NOTIFY THE BOOKING AGENT IMMDEIATELY.

SIGNATURE _______________________________________________________ DATE _________________