League Season - November 6, 13 & 20

LEAGUE SEASON

November 6th, 13th & 20th

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I am available for the following areas: (circle one)

15 Corridor Coastal Del Mar Sharks Fallbrook FC San Diego Nomads Poway / Scripps area San Marcos Matrix Valley Center Any Field

WILL BE AVAILABLE AS FOLLOWS:

NOVEMBER 6TH SATURDAY AM PM

NOVEMBER 13TH SATURDAY AM PM

NOVEMBER 20TH SATURDAY AM PM

COMMENTS: ___________________________________________________________________

NAME __________________________________________________ AGE _________________

ADDRESS _______________________________________________________________________

PHONE W/ AREA CODE _______________________ 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 2010 YES NO

ASSOCIATION DUES PAID 2010? YES NO

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

ARE YOU CURRENTLY ON THE EMAIL LIST? YES NO

SEND TO LEANNE HARRIS FAX: 760-728-1261