Every effort will be made to honor your preferences if
enough referees are available. Use below area for additional
information
*First Name:
*Last Name:
*Home Phone:
(ex. 804-555-5555)
Cell Phone:
(ex. 804-555-5555)
Work Phone:
(ex. 804-555-5555)
Fax:
(ex. 804-555-5555)
Date of Birth:
(ex. 01/01/1980)
*Email:
SSN:
(ex. 111-11-1111)
Address:
City:
State:
Zip:
I Play/Coach for:
(ex. KIC15C)
Other team conflicts:
(ex. sibling, child, etc.)
Do not schedule me during these match times as I prefer to watch. Yes: No:
Conflicts or other notes to the assignor:
I certify I am a current USSF Official in good standing and to the best of my knowledge,
the information above is true and correct. I further understand that full match
fees are based on compliance with the USSF Code of Ethics & Conduct.
* Check this box to certify the above statement
This is an update of a previously submitted availability form.
