PEIBUA 2025 Registration Form
Please complete prior to certification
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
-
Area Code
Phone Number
Secondary Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Confirm Email
*
example@example.com
Current Umpire Level
*
New Umpire
Level 1
Level 2
Level 3
Level 4
Level 5
Home Association
*
Bedeque
Charlottetown
Cornwall
Kensington
Northside
Sherwood-Parkdale
Souris
Stratford
Summerside
Three Rivers
Western
PEIBUA High Performance
*Level 3 Umpires Need Confirmation From Minor Baseball Association on coverage of registration fee.
Will you be a Player and/or Coach within Baseball PEI
*
Yes
No
Clinic Attending
Please Select
Apr 5, High Performance (Summerside)
May 3, UPEI
May 10, Summerside Intermediate School
May 24, Montague Regional High School
May 31, Tignish Rec Centre
Please choose a clinic to register for
Permission Section: I give permission to the use of umpire related photos for any PEIBUA website and/or PEIBUA Social Media postings
*
Yes
No
If under the age of 18, Parent/Guardian signature permitting the above
Effective 2019 all payments to Umpires are done by direct deposit through your local Consolidated Credit Union, please include your Consolidated Credit Union account/branch number or an attached Direct Deposit Form.
If you have any questions please send to peibua@gmail.com
Direct Deposit Form
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