2011 League Season - November 5, 12 & 19

2011 LEAGUE SEASON

November 5th, 12th & 19th, 2011

___________________________________________________________

AREA AVAILABLE TO WORK IN:

ANY FIELD (Leanne) - NOTT'S FOREST (Mark Wolfe/Leanne) - VALLEY CENTER (Leanne) - SDSC (Leanne) - NOMADS (Leanne) - DEL MAR SHARKS (Leanne)

POWAY (Leanne) - FALLBROOK (Brian Koenig) - VISTA (Mike Malik) - PACIFIC BEACH (Tom Schoettle/Bob Petterson)

CHULA VISTA PUMAS (Jesse Acevedo/ Bob Petterson) - CARLSBAD LIGHTNING (Manny Villalta) - OCEANSIDE BREAKERS (Manny Villalta)

WILL BE AVAILABLE AS FOLLOWS:

NOVEMBER 5TH SATURDAY AM PM

NOVEMBER 12TH SATURDAY AM PM

NOVEMBER 19TH SATURDAY AM PM

COMMENTS: ___________________________________________________________

NAME __________________________________________________ AGE _________

ADDRESS ______________________________________________________________

PHONE W/ AREA CODE _______________________ CELL# _____________________

YEARS OF REFEREE EXPERIENCE _____

EMAIL __________________________________________________________________

I AM COMFORTABLE AT THE FOLLOWING LEVEL:

REFEREE U/__________________________________ BOYS GIRLS

AR U/__________________________________ BOYS GIRLS

CURRENT USSF REFEREE GRADE _______________________________

YEAR ATTAINED CURRENT GRADE _____________________________

I AM CURRENTLY REGISTERED USSF FOR 2011 YES NO

SDSRA ASSOCIATION DUES PAID 2011? YES NO

I HAVE COMPLETED THE RISK MANAGEMENT REQUIREMENT (18+ YEARS OLD ONLY) YES NO

PRESIDIO ID CARD IN MY POSSESSION? YES NO

HOTEL NEEDED? YES NO

ARE YOU CURRENTLY ON THE EMAIL LIST? YES NO

SEND TO LEANNE HARRIS 1227 S. MISSION RD. FALLBROOK, CA 92028

FAX: 760-728-1261