Midwest Cup 2008 Soccer Referee Data

PERSONAL INFORMATION last name : first name :
address : city : ZIP :
email :

Telephone home number :
alt. number : 2d home phone cell work

date of birth (mm/dd/yyyy) :

REFEREE DATA USSF Referee Grade :

Please complete the following as accurately as possible. Be honest in your abilities. If anything, take a lower level at the beginning of the season and let me know you want to move into more difficult games.

I am comfortable doing games as a CENTER up to
I am comfortable doing games as an ASSISTANT REFEREE up to

AVAILABILITY and CONFLICTS

Please completely read all the following and check those which apply.

Will you be playing on a team at the tournament? yes no
If yes, indicate team in space below. (indicate Name, age and gender)

Will you be coaching a team in the tournament? yes no
If yes, what team? (indicate Name, age and gender)

Please identify any other known conflicts below.

Your Availability by Date
Please indicate your availability for each date below.
This information will be used to determine initial game assignments. If your availability changes before you receive assignments, please contact me to advise of the change.
FRIDAY May 23 4:30pm - 7:30pm: Not available:	SATURDAY May 24 7am - 12pm: 10am - 3pm: 12pm - 6pm: 3pm - 6pm: All Day: Not available:

SUNDAY May 25
7am - 12pm:
10am - 3pm:
12pm - 6pm:
3pm - 6pm:
All Day:
Not available:

MONDAY May 26
7am - 12pm:
10am - 3pm:
All Day:
Not available:

COMMENTS

Any additional comments may be included here.

ADDITIONAL FORM

Once you submit this registration, you need to complete the Medical and Liability Release form found here. It is required by the IYSA.

Fields in RED are required.