WFTDA Skating Official Application for 2013 Playoffs

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In order to apply to perform as a Skating Official in the 2013 WFTDA Playoff Cycle, this form must be submitted no later than 5/28/2013.

Derby Name *

Legal Name *

League Affiliation *

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

Certification Level *

Please copy/paste the link to your officiating history document *

Document will be downloaded and saved on WFTDA resource at the time of application.

Reference #1 (Name and Email) *

Reference #2 (Name and Email) *

Email Address *

Phone # *

Insurance # (if applicable) *

Position Applications

NOTE: Applying to CHR will be considered an automatic application to IPR as well (you may not apply to CHR without applying to IPR).

D2 - Des Moines, IA Aug 16-18

CHR

IPR

OPR

D2 - Kalamazoo, MI Aug 23-25

CHR

IPR

OPR

D1 - Fort Wayne, IN Sept 6-8

CHR

IPR

OPR

D1 - Richmond, VA Sept 12-15

CHR

IPR

OPR

D1 - Asheville, NC Sept 20-22

CHR

IPR

OPR

D1 - Salem, OR Sept 27-29

CHR

IPR

OPR

Championships - Milwaukee, WI Nov 8-10

I would like to be considered for a role at Championships

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

Yes

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

Yes

I understand that I may be chosen for the role of Alternate, and agree to accept this position if invited *

Yes

Notes

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

Submit

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