| Name: |
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| Cell Phone #: |
Home Phone #: |
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| Address: |
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| Email address: |
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| Experience Level (state the number of games for 06-07 season below each): |
| Div I: |
Div II: |
Div III: |
High School: |
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Camp Fee is $250.00 per official and does not include housing or meals.
If you want to receive credit for the Georgia High School Camp
requirement, please send a separate check for payable to the GHSA for
$50.00. You must pay the $250.00 Peach Belt Camp Fee to be eligible for
the GHSA instruction.
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Signature of Offficial
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Date
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Check Number
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Money Order
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Make checks payable to:
PBOA
1619 Ellington Road
Conyers, GA 30013
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