Application for Membership

Please complete this form for consideration to become a certified NHTOA official.

Enrollment will not be permitted or renewed for anyone:

1. Convicted, or adjudicated with a finding of fault, guilt, or violation, in regard to an offense against a minor or any sexual offense unless/until such offense has been reversed by proper authority with jurisdiction over the matter; or
2. Convicted, or adjudicated with a finding of fault, guilt, or violation, in regard to an offense involving any illegal/illicit drug or controlled substance as prescribed by federal or state law or regulation.

Email *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone

List any other sports you are certified in. Include the sport, the state where certified, and the years you have been certified:

Are you USATF certified?

• Yes
• No

Track & Field/Cross Country clinics or rules reviews, if any, you have attended in the past two years:

Events you have experience with, either as a competitor or officiating:

• None. I am ready to learn.
• Starter
• Timer
• Finish Line
• Clerk
• Inspector (Umpire/Exchange Zone Judge)
• Track Events Referee
• Field Events Referee
• Wind Gauge Operator
• Long Jump
• Triple Jump
• High Jump
• Pole Vault
• Shot Put
• Discus
• Javelin

Experience with Track & Field and/or Cross Country:

Briefly describe any experience you have with Track & Field and/or Cross Country. Include any special skills or interests you have.

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