*City:
*State:
*Zip:
Previous experience with basketball:
Coached The Game?:
Officiated The Game?:
Why do you want to become a basketball official?:
Do you officiate any other sport? Please list each sport:
Where did you hear about CWGBO and/or who referred you?:
Are you finger printed and registered with NYSPHAA?:
The clinic dates run each year from September and into November. Attendance at each class is very important. There is a $85.00 fee for the clinic due at the first class.