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2006 USWOA Membership Application
Annual Dues $25
Valid September 1, 2005 through August 31, 2006

Please type the following information into the form below, print the page, and mail to the address indicated at the bottom of the form:

Name:
Mailing Address:
City: State: Zip:
Home Phone:   Office Phone:
Fax:   Email:

Check all that apply:   New Applicant   Mat Official   Pairing Official
Check "new applicant" if you are applying for the first time.

If you are under 18 years old, you must list your date of birth:
Renewal Present Category License #

APPLICANT ACKNOWLEDGES THAT HE/SHE SHALL BE BOUND BY THE BY LAWS OF THE UNITED STATES WRESTLING OFFICIALS ASSOCIATION AND USA WRESTLING.


A 2006 stamp and control card is included as part of your $25 Dues fee.

If you lose your original stamp:
The cost of a replacement USWOA License Book is $5.00
The cost of a replacement USWOA Stamp is $2.00
We do not order enough stamps to provide 2 stamps for so many.


If you would like to send a contribution to the Officials’ Room at the National Wrestling Hall of Fame in Stillwater, Oklahoma, please note the amount of your contribution below and add that amount to your dues. Your contribution will be forwarded to the National Wrestling Hall of Fame.
Yes, I wish to contribute to the Officials' Room. Additional amount enclosed: $

Send completed membership application and payment for dues to:
USWOA
6155 Lehman Drive
Colorado Springs, CO 80918
Phone 412/486-8997   Fax: 412/486-9142
email: uswoaoffice@verizon.net
Make all checks payable to : “USWOA”