FC Richmond's Richmond Cup

Old Dominion Soccer Referee Service

Out of Area Referee Tournament Availability

2011 FC Richmond 's Richmond Cup

September 3^rd & 4^th, Throughout the Metro Richmond Area

Availability is being sought for the 2011 FC Richmond's Richmond Cup Soccer Tournament being played throughout Chesterfield County over Labor Day Weekend. Please indicate the periods you are available and would like to work matches by checking the appropriate boxes. Note that if you are participating in the tournament and would like to work, it is important that you fill in any conflicts and / or team affiliation as 1 or 2 assignments can often be scheduled around match times (unless requested, at least 1 match break is considered both before and after players’ match times). Please use the official name of your team for the Fall 2011 season (i.e. FCR15C).

Submit this completed form to the Tournament Assignor David Hichak by Aug 1^st for full consideration. Assigning of games will start the week of Aug 7^th. Preliminary assignments will be posted on Game Officials website (www.gameofficials.net) by Aug 21^st.

Check the boxes for the date & times when you are available.

* Indicates required field.
Saturday, Sept. 3^rd .	AM	PM
Sunday, Sept 4^th .	AM	PM
Maximum # of matches per day preferred:		2 3 4 5+
Schedule break after games
Shirt Size: (Adult S, M, L, XL)

I'm sorry, I'm not available to work this tournament.

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)
Date of Birth:	(ex. 01/01/1980)
*Email:
SSN:	(ex. 111-11-1111) Only if new to ODSRS
Address:
City:
State:
Zip:
Shirt size:	(Adult S, M, L, XL)
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:	(9, 8, 7, 6, 5)
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 "most 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 the state's SRA. I certify I am a current USSF Official in good standing and 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.