New Member Application

If you are interested in joining the Rock River Officials Association, please attend a meeting and announce your intentions.  A listing of meeting dates and times can be found on the website.  A copy of the membership application can be downloaded from the file sharing page of this website.  Below is a sample of the application.  We look forward to you joining our association.

				Rock River Officials Association
				Registration and Dues Application Form
				2011-12 Season
All my personal information, as listed on the RROA web site, is current…							YES:	NO:
	NAME:
	ADDRESS:
	CITY:					ZIP:
	HOME PHONE:					AGE:
	OTHER PHONE:					D.O.B.
	EMAIL ADDRESS:
	* Must have email
I am currently a licensed official in the state of Illinois…						YES:	NO:
If YES, my I.H.S.A. identification number is...					#
If NO, I plan to get/have my license by this date…
	SPORT:			LEVEL OF CERTIFICATION:			Years officiated
			Registered	Recognized	Certified		in this sport
	Baseball
	Basketball
	Football
	Soccer
	Softball
	Track/Field
	Volleyball
	Wrestling
Membership - $40.00 (due on/before June 30th)					Amount:	$
Student Membership	- $15.00				Amount	$
Late Fee - $10.00 (after June 30th)					Amount:	$
					Total:	$
Make checks payable to R.R.O.A.
Please mail this completed form with payment to:
John Kereven, Treasurer
Rock River Officials Association
313 Ada Street
Rock Falls, Illinois  61071
				All information listed is accurate as of this date…
				Signature:
				Date: