WFTDA THNSO Application for 2013 Playoffs

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In order to apply to THNSO in the 2013 WFTDA Playoff Cycle, this form must be submitted no later than 5/22/2013

Derby Name

Legal Name

League Affiliation

Certification Level

In the last 12 months, approximately how many WFTDA Sanctioned/Regulation games have you performed as a non-skating official?

Please copy/paste the link to your officiating history document

Reference #1 (Name and Email)

Reference #2 (Name and Email)

Email Address

Phone #

WFTDA Insurance # (if applicable)

Tournament applying for (check all that apply)

D2 - Des Moines, IA Aug 16-18

D2 - Kalamazoo, MI Aug 23-25

D1 - Fort Wayne, IN Sept 6-8

D1 - Richmond, VA Sept 12-15

D1 - Asheville, NC Sept 20-22

D1 - Salem, OR Sept 27-29

Championships - Milwaukee, WI Nov 8-10

I have read the tournament eligibility document, and certify that I meet the minimum requirements for application

Yes

Clear selection

I understand that all staffing decisions are subject to approval by the Tournament Officials Selection Panel

Yes

Clear selection

Notes

Please list any additional items you would like the Panel to consider along with your application

Submit

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