MRDA 2013 Championships: Officials' Application
The MRDA Championships will be taking place on October 19-20, 2013 at  the Long Lines Family Recreation Center located at 401 Gordon Drive, Sioux City, IA 51102. https://www.sioux-city.org/llfrc The submissions deadline for general applications is Friday August, 23, 2013.  Submission deadline for those interested in THR/THNSO positions is Friday, July 12, 2013. For more details on this Tournament please contact mrda2013Officials@gmail.com.
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Full Name: *
Derby Name: *
Address: *
Email Address: *
Phone Number: *
League Affiliation (or independent): *
Affiliated league’s parent organization: *
MRDA Certification: *
WFTDA Certification: *
Position(s) you are applying for: *
Are you interested in being a THR/THNSO for this event?  If you are also interested in applying to THR/THNSO this event, please indicate that here: *
Are you interested in being a CHR or CHNSO for this event? *
Are you interested in being an Apprentice THR or THNSO for this event? *
IMPORTANT INFORMATION FOR THR/THNSO APPLICANTS.
**Please be aware that the deadline to express interest in being a THR/THNSO is Friday, July 12, 2013. Applications for these positions received after this date will only be considered for regular Skating and Non-Skating Official positions.

***For those parties interested in being a THR/THNSO for this event- please also send an email with your relevant experience in being a THR/THNSO for this event to mrda2013Officials@gmail.com by the July 12, 2013.

Your application and this explanatory email must be received by the deadline date in order for your application to be considered for these position. You do not need to include your resume with this email, as we will have that with this application form.
Tournament Position Information
Positions you are capable of performing: *
Positions you are NOT capable of performing : *
RECENT TOURNAMENT EXPERIENCE
Please list your most recent tournament experience. Specify number of bouts worked and position held. If you have additional tournament experience we will see that on your officiating resume.
Tournament Name:
Position(s) Held:
Number of bouts worked:
Tournament Name:
Position(s) Held:
Number of bouts worked:
Tournament Name:
Position(s) Held:
Number of bouts worked:
Non-tournament Experience
If you do not have your officiating resume in an online format (google doc for example) please email it to mrda2013officials@gmail.com.
Link to officiating resume * or please note that is has been emailed. *
Skating Ability: *
Weak
Strong
Do you have an experience with Rinxter? If yes, please elaborate. *
T-Shirt Size: *
Do you have a MRDA NSO Shirt to bring? *
Reference 1
Full Name: *
Derby Name: *
League: *
Email: *
Work relationship with applicant: *
Reference 2
Full Name: *
Derby Name: *
League: *
Email: *
Work relationship with applicant: *
Reference 3
Full Name: *
Derby Name: *
League: *
Email: *
Work relationship with applicant: *
Insurance
This is not a USARS event. If you have any other insurance besides WFTDA/MRDA you will be required to fill out a waiver in order to participate.
WFTDA/MRDA Insurance: *
Other Insurance:
*Company
Other Insurance:
*Liability Limit
Emergency Contact Information
Emergency Contact Name: *
Phone Number: *
Relationship: *
Medical Conditions and Allergies: *
Disclaimer
By submitting this I am attesting that I have read and understand the job description of the position for which I am applying. I also understand it is my own responsibility to provide transportation and hotel accommodation unless specified in the job description. Additionally by submitting I confirm my availability to work on October 19 and 20, 2013 in Sioux City, IA. I will also make myself available for a mandatory Officials' Meeting on Friday night (10/18/13) time and location TBA.
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