Nomads (Youngers) - (Leanne/Tom)

NOMADS (YOUNGERS) - (LEANNE / TOM ASSIGN)

March 17th & 18th, 2012

___________________________________________________________

WILL BE AVAILABLE AS FOLLOWS:

MARCH 17TH SATURDAY AM PM

MARCH 18TH SUNDAY 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 2012 YES NO

SDSRA ASSOCIATION DUES PAID 2012? YES NO

I HAVE COMPLETED THE RISK MANAGEMENT REQUIREMENT (18+ YEARS OLD ONLY) 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