REFEREE APPLICATION
 
Biographical Information
 
First Name           Last Name 
 
Address   City     
State                                   Zip Code                      

Email  
 
Home Telephone (ex. 502-555-5555)          
Work Telephone (ex. 502-555-5555)        
Cellular Telephone (ex. 502-555-5555)         
 
Date of Birth (ex. 01/25/82)         
 
 
   
License Information
 
Are you currently registered for 2008?  
Yes No
Referee Grade
(Most Referees begin at a Grade 8)
9 8 7 6 5 4 3
Referee Patch is Blue
Patch says "Referee"
Patch says
"State Referee"
Patch says
"National Referee"
 
Years of Experience
 
 
 
 
Availability
(Please check ALL that apply)
By checking a time box, you are advising your availability for one hour, beginning at that time.  For example, by selecting 7AM, I would be advising that I am available from 7:00AM until 8:00AM.
FRI
 
  
 
 
 
 
 
 
 
3PM
4PM
5PM
6PM
7PM
8PM
SAT
 
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
SUN
 
7AM
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
 
 
Conflicts
(If you don't have any conflicts, please SKIP this section.)
(In this section you can identify the teams or clubs that you don't want to be scheduled to referee.  For example, if you play, coach, or have a relative on a team, please list the Team Name, Age Group, and Gender.  If you have an affiliation with a club and not a specific team, please list them under the Club Conflict section.  I will make every effort possible NOT to schedule you into these games/time slots.)
 
Team Conflict #1
Team Name     Club Name
Age Group (ex. U-16)   Gender (ex. M or F)
 
Team Conflict #2
Team Name     Club Name
Age Group (ex. U-16)   Gender (ex. M or F)
 
Team Conflict #3
Team Name     Club Name
Age Group (ex. U-16)   Gender (ex. M or F)
 
Club Conflict #1   or   NOTES TO THE ASSIGNOR
Club Name
 
Club Conflict #2    or   NOTES TO THE ASSIGNOR
Club Name
 
 
Hotel Room Request
(You must be willing to work at least 4 games per day to be eligible for a room.)
FRIDAY NIGHT
SATURDAY NIGHT