LPSRA Membership Form

Contact Information

First & Last Name This field must contain first and last name. No numbers or symbols

Email Address This field must contain email address

Cell Phone This field must contain a phone number

Spoken Languages (Check all that apply) English Spanish

Current Certifications

USSF

USSF You must select a vaue from the dropdown

Number of Years This field must contain a Number

Referee Grade

NFHS

NFHS (High School) You must select a vaue from the dropdown

Number of Years This field must contain a Number

NISOA

NISOA (Div 1 College) You must select a vaue from the dropdown

Number of Years This field must contain a Number

Interests

Check all boxes below that apply to what you are looking to be invovled in

USSF Games Spring League (Sat & Sun) Fall League (Sat & Sun) Tournaments (Fri, Sat & Sun) College Club Games

Other Games High School Games (Mon-Sat) Middle School Games (Mon-Sat) Women's League Games (Sun) Beach Soccer (Sat & Sun) Short Sided Games (Sat & Sun)

Serving on Board Instruction Assigning Games Referee Evaluations Other Serving Opportunities

Additional Information we shoudl know about you

2019 Membership Dues

Membership Dues are for all games (not including high school) with NO game fees and NO assigning fees.
For Ages 18 - 65 Dues are $75 with multiple payment options
For Ages before 18 and after 65 Dues are $40. Due at once

Select the payment options.
You will be sent an invoice if you choose Credit Card or Debit Card (processing fee will be added).
You will receive an email with instructions if you choose Arbiter Pay

$75 Membership Dues Payment Otions You must select a vaue from the dropdown

Select how you would like to pay You must select a vaue from the dropdown