Last Name
First Name
Middle Name
Nick-Name (Name you go by)
Date of Birth ( Format : mm/dd/yyyy )
I want my mail (and payments) sent to my:
Home Address (Required)
Mailing Address (Optional)
Street Address
Apartment #
City
State
Zip Code
Mailing Address
City
State
Zip Code
Email Address
Phone Numbers ( Format : ###-###-#### )
Home
Cell
Employer
Work Phone Number ( Format: ###-###-#### )
Emergency Contact (The person/ information to contact in case of an emergency)
Name
Emergency Contact #
Relationhip
What is the highest level you have officiated?
How many years experience do you
have officiating?
Baseball
Softball
Do you have Post Season experience in
this sport?
Have you ever been registered as an official with GHSA?
Are you registered with another association in any sport?
If "YES", which association?
Are you registered as a high school official in another state?
If "YES", which State?
The GHSA prohibits members from officiating at schools where a conflict may occur.
These limitations include not accepting an assignment at a school from where you graduated within the last 10 years, at a school where you are employed, had player-coach contact previously with any coach involved, or have relatives affiliated with a school as a student or an employee.
If "YES", which School(s) ?
Continue
Form W-9
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Name (as shown on your income tax return)
Business Name (If Different from above)
Check appropriate box for federal tax classification:
Address (Number, street and apt. or suite number)
City, State and ZIP Code
Enter your TIN in the appropriate box. The TIN provided must match the name given on the ‘Name” line to avoid backup withholding. For individuals, this is your social security number (SSN).
Social Security Number
Employer Identification Number
OR
-
-
-
Under penalties of perjury, I certify that: 
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 
3. I am a U.S. citizen or other U.S. person (defined below), and 
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. 
Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Notification required by law:

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

This substitute form meets the requirements of the Internal Revenue Service Code, Rev. Proc. 83-89, 1983-2 C.B. 613; amplified by Rev. Proc. 96-26.
Sign
Here
Signature of
U.S. Person
By my Signature hereon, I affirm that I am electronically signing this form.
Date
With this statement, do you have any conflicts at a school where SOA officiates?
Continue
Statement of Understanding and Consent

As a member of the Heritage Officials Association, hereinafter referred to as “HOA”, I UNDERSTAND AND AGREE THAT:

I will follow and adhere to the standards and requirements contained within the HOA Constitution and Standard Operating Procedure;

My services as an Independent Contractor are appreciated for a period of one (1) year unless earlier terminated; I am required to sign a new Independent Contractor Agreement each year that I umpire with the HOA; I am an independent contractor and not an employee of the HOA or any institution, agency, league or team that HOA provides services for; I will be issued compensation for my services based on information provided to the Secretary-Treasurer and after all game fees have been collected from the school, team or league. I understand that administrative fees (in accordance with the HOA Bylaws) will be withheld from my game pay.

I ALSO UNDERSTAND AND AGREE THAT: HOA does not provide, in policy or premium, insurance to cover any injury or damage while performing services for the HOA. In the event I am injured while at or traveling to and/or from any game(s), I will not to hold any member of the HOA liable in any manner what-so-ever. Sports officials registered with the Georgia High School Association (GHSA) are covered by insurance provided by the GHSA for games sanctioned by the GHSA-no other insurance is provided. The HOA strongly encourages each independent contractor to obtain liability and injury insurance.

I ALSO AGREE to abide by the GHSA Officials' Code of Ethics and Standard of Conduct as follows:

Each Official Shall:
  • 1. Constantly uphold the honor and dignity of the avocation of officiating in all personal conduct and relations with the student-athletes, coaches, administrators, fellow-officials, and the general public.
  • 2. Devote time, thought, and study to the rules of the game and to the mechanics necessary to apply these rules so that the officiating performance will be carried out in a fair and professional manner. An official must be prepared both physically and mentally, dress according to expectations, and maintain a proper appearance that is befitting the professional image of an official.
  • 3. Uphold the By-Laws and the legal regulations of the GHSA – being aware that high school officiating involves a public trust.
  • 4. Exercise a high level of integrity when entering into contractual negotiations with GHSA schools.
  • 5. Never discriminate unfairly by dispensing special favors or privileges to anyone (whether for remuneration or not); and never accept favors or benefits under circumstances which might be construed by reasonable persons as influencing the performance of one's officiating duties.
  • 6. Make no private promises of any kind binding upon the duties of officials since a GHSA official has no private word which can be binding on public duty.
  • 7. Expose corruption and breaches of integrity wherever discovered.
  • 8. Work with fellow officials, the Georgia High School Association, and any other league or sports organization, in a spirit of harmony and cooperation in spite of differences of opinion that may arise.

STANDARDS OF CONDUCT

Each GHSA official must avoid any action, whether specifically prohibited by this code or not, which might result in or create the appearance of a violation of these standards of conduct which include, but are not restricted to:
  • 1. Using one's position as a GHSA official for private gain – exclusive of payment for games worked. (No official shall seek to influence a coach or administrator for the purpose of promoting personal officiating opportunities.)
  • 2. Giving preferential treatment to any school or coach.
  • 3. Being involved in any action that gives the appearance of a loss of impartiality or neutrality. No official should accept any assignment at a school where he/she graduated within the last 10 years, at a school where he/she is employed, had player-coach contact previously with any coach involved, or has relatives affiliated with a school as a student or an employee. 
  • 4. Making a GHSA decision outside of official channels.
  • 5. No member will engage in criminal, dishonest, notoriously disgraceful, or immoral conduct – or any other conduct adversely affecting the confidence of the public or member schools in the integrity of the Georgia High School Association.
  • 6. No member shall engage in any behavior that can be defined as sexual harassment by a reasonable person.
  • 7. Use any substance prior to officiating a game/match that would impair his/her physical or mental performance. An official should not use alcoholic beverages at all on the day of a game/match.
  • 8. While wearing any article of clothing that identifies the individual as a sports official, each member's speech and actions during or enroute to or from a game/match shall be above reproach and should always demonstrate a strong example of sportsmanship, courtesy, and self-control.
  • 9. No official shall criticize any other official or any association within the GHSA in the presence of coaches, administrators, players, spectators, or the media before, during, or after a game/match.
  • 10. No official shall fail to honor an officiating contract.

I also understand that, under Georgia law, O.C.G.A. 13-10-91 and the United States Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603, Contractors and Sub-contractors are required to register and participate in the electronic federal work authorization program operated by the United States Department of Homeland Security to verify information of sub-contractors. I agree, if approved by HOA as a sub-contractor, to release HOA and authorize HOA to submit on my behalf necessary information for the purpose of compliance and I also agree to the release of the records generated as a result of compliance to those government agencies requiring a Contractor Affidavit and Agreement. I understand that I have the option to register with and participate in the federal work program on my own behalf and, if I elect to do so, I will furnish HOA a separate Contractor Affidavit and Agreement under O.C.G.A. 13-10-91 on a form prescribed in Rule 300-01-08 or a substantially similar form;

All Heritage members are required to pay annual membership dues at the start of each year or upon joining Heritage. The Georgia High School Association, and any other association with which we are affiliated, also requires annual payment of fees for each sport you officiate (baseball and/or softball). Payment of all fees is required before you can participate as an umpire. 
Make checks for HOA dues and GHSA fees payable to Heritage Officials Association.

I have reviewed the information entered by me in this application form and certify that this information is true and accurate. I have read the Statement of Understanding and the Standards of ConductBy entering my name in the signature box below, I understand that I am electronically signing my name.
Signature
Date
Verify Your Email Address (enter it again)
Enter Your Social
Security Number Again
( Format:  # # # # # # # # # -- No spaces, dots or dashes)
Application For Membership
Each section must be completed.
Information left blank will be returned to you for completion before you are allowed to enter a submission.
Membership Status
I desire to officiate the following sports:
Statement of Understanding and Consent

As a member of the Heritage Officials Association, hereinafter referred to as “HOA”, I UNDERSTAND AND AGREE THAT:

I will follow and adhere to the standards and requirements contained within the HOA Constitution and Standard Operating Procedure;

My services as an Independent Contractor are appreciated for a period of one (1) year unless earlier terminated; I am required to sign a new Independent Contractor Agreement each year that I umpire with the HOA; I am not an employee of the HOA or any institution, agency, league or team that HOA provides services for; I will be issued compensation for my services based on information provided to Secretary-Treasurer and after all game fees have been collected from the school, team or league. I understand that administrative fees (in accordance with the HOA Bylaws) will be withheld from my game pay.

I ALSO UNDERSTAND AND AGREE THAT: HOA does not provide, in policy or premium, insurance to cover any injury or damage while performing my duties with the HOA. In the event I am injured while at or traveling to and/or from any game(s), I will not to hold any member of the HOA liable in any manner what-so-ever; Umpires registered with the Georgia High School Association (GHSA) are covered by insurance provided by the GHSA for games sanctioned by the GHSA-no other insurance is provided. The HOA strongly encourages each independent contractor to obtain liability and injury insurance.

I ALSO AGREE to abide by the GHSA Officials' Code of Ethics and Standard of Conduct as follows:

Each Official Shall:
  • 1. Constantly uphold the honor and dignity of the avocation of officiating in all personal conduct and relations with the student-athletes, coaches, administrators, fellow-officials, and the general public.
  • 2. Devote time, thought, and study to the rules of the game and to the mechanics necessary to apply these rules so that the officiating performance will be carried out in a fair and professional manner. An official must be prepared both physically and mentally, dress according to expectations, and maintain a proper appearance that is befitting the professional image of an official.
  • 3. Uphold the By-Laws and the legal regulations of the GHSA – being aware that high school officiating involves a public trust.
  • 4. Exercise a high level of integrity when entering into contractual negotiations with GHSA schools.
  • 5.Never discriminate unfairly by dispensing special favors or privileges to anyone (whether for remuneration or not); and never accept favors or benefits under circumstances which might be construed by reasonable persons as influencing the performance of one's officiating duties.
  • 6. Make no private promises of any kind binding upon the duties of officials since a GHSA official has no private word which can be binding on public duty.
  • 7. Expose corruption and breaches of integrity wherever discovered.
  • 8. Work with fellow officials and the Georgia High School Association in a spirit of harmony and cooperation in spite of differences of opinion that may arise.


STANDARDS OF CONDUCT

Each GHSA official must avoid any action, whether specifically prohibited by this code or not, which might result in or create the appearance of a violation of these standards of conduct which include, but are not restricted to:
  • 1. Using one's position as a GHSA official for private gain – exclusive of payment for games worked. (No official shall seek to influence a coach or administrator for the purpose of promoting personal officiating opportunities.)
  • 2. Giving preferential treatment to any school or coach.
  • 3. Being involved in any action that gives the appearance of a loss of impartiality or neutrality. No official should accept any assignment at a school where he/she graduated within the last 10 years, at a school where he/she is employed, had player-coach contact previously with any coach involved, or has relatives affiliated with a school as a student or an employee. 
  • 4. Making a GHSA decision outside of official channels.
  • 5. No member will engage in criminal, dishonest, notoriously disgraceful, or immoral conduct – or any other conduct adversely affecting the confidence of the public or member schools in the integrity of the Georgia High School Association.
  • 6. No member shall engage in any behavior that can be defined as sexual harassment by a reasonable person.
  • 7. Use any substance prior to officiating a game/match that would impair his/her physical or mental performance. An official should not use alcoholic beverages at all on the day of a game/match.
  • 8. While wearing any article of clothing that identifies the individual as a sports official, each member's speech and actions during or enroute to or from a game/match shall be above reproach and should always demonstrate a strong example of sportsmanship, courtesy, and self-control.
  • 9. No official shall criticize any other official or any association within the GHSA in the presence of coaches, administrators, players, spectators, or the media before, during, or after a game/match.
  • 10. No official shall fail to honor an officiating contract.

I also understand that, under Georgia law, O.C.G.A. 13-10-91 and the United States Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603, Contractors and Sub-contractors are required to register and participate in the electronic federal work authorization program operated by the United States Department of Homeland Security to verify information of sub-contractors. I agree, if approved by HOA as a sub-contractor, to release HOA and authorize HOA to submit on my behalf necessary information for the purpose of compliance and I also agree to the release of the records generated as a result of compliance to those government agencies requiring a Contractor Affidavit and Agreement. I understand that I have the option to register with and participate in the federal work program on my own behalf and, if I elect to do so, I will furnish HOA a separate Contractor Affidavit and Agreement under O.C.G.A. 13-10-91 on a form prescribed in Rule 300-01-08 or a substantially similar form;

All Heritage members are required to pay annual membership dues at the start of each year or upon joining Heritage. The Georgia High School Association, and any other association with which we are affiliated, also requires annual payment of fees for each sport you officiate (baseball and/or softball). Payment of all fees is required before you can participate as an umpire. 
Make checks for HOA dues and GHSA fees payable to Heritage Officials Association.
I have a high school education OR a GED
Education (GHSA required question)
Experience
Have you ever been convicted of a crime other than a traffic violation?
If "YES", What?
If you are individually structured as a business and have an employers tax ID number (TIN) and you want to use your company tax ID number, enter that number here. While most members file taxes as individuals, the IRS requires this option on this form.
Read this before proceeding:

  • If you have never joined Heritage, complete the application below and after completing the application, follow the link to the GHSA application.



Youth Baseball (Other than GHSA)
Youth Softball (Other than GHSA)
High School Baseball
High School Softball
Both High School Sports
All Softball
All Baseball
All Sports
I was a member last year
I WAS NOT a member last year
Home Address Mailing Address
Yes No
Yes No
Yes No
Yes No Not Sure
Yes No
Individual/Sole Proprietor C Corporation S Corporation Partnership Trust/Estate