Registration Form

Instructions

1.) Complete Form Below.

2.) Once completed, click the "Submit" button at the bottom of the page.

3.) Review your information and click "Please Confirm" at bottom of page.

4.) Print completed form and mail with check (instructions below form) to ECAC.

Email address *
First name *
Last name
SS#:
Sport (Please indicate men's or women's)
Application Date: Month/Day/Year
Street Address:
City, State, Zip:
Phone (Day): *
Phone (Evening):
Phone (Cell):
Occupation:
Are you planning to attend an upcoming ECAC Officiating Clinic?
  Yes
  No
If yes, which clinic?
(Date, Location, Sport)

Education

High School:
College (if applicable):
Other:
Current and Past Officiating Memberships
References (Please list names, addresses and phone numbers of three references who can attest to your officiating abilities)

 

Mackenzie Larsen, Coordinator of Sport Administration - Officiating
ECAC
39 Old Ridgebury Road
Danbury, CT 06810

Important Note: All new applicants submitting the registration form above will NOT automatically be approved into ECAC membership. After submitting the ECAC registration form, new applicants must be subsequently approved for membership by the ECAC Coordinator and by the certifying officials' organization in the sport bureau (i.e. men's basketball, soccer, baseball) for which the applicant has applied.

 

 
* = required field