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. RKY15)
Other team conflicts:
(ex. sibling, child, etc.)
Do not schedule me during these match times as I prefer to watch. Yes: No:
Self Rating (Center):
(U-??, B, SM, etc.)
Self Rating (Lines):
(U-??, B, SM, etc.)
Current USSF Referee Grade:
Club/League/Area:
(where you referee most)
Primary Assignor:
Assignor's Phone Number:
(ex. 804-555-5555)
Assignor's Email:
Conflicts or other notes to the assignor:
Note to Out of State
Referees:
The USSF administrative manual states that any referee traveling outside
his/her home state "must inform the SRA/SYRA when traveling out of the state
association to work games" for permission. Names of visiting referees working
ODSRS tournaments will be forwarded to the Metro-DC State Referee Office for
verification that any visiting referee is in good standing with USSF as well as
that state's SRA.
I certify that I am a current USSF Official in good standing and the above
information is true and correct to the best of my knowledge. 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.
