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FICHE DE RENSEIGNEMENTS ARBITRE 2025/2026
FICHE A REMPLIR POUR LE 30 SEPTEMBRE 2025
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Email
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Your email
SPORT
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Choose
BASKET-BALL
BASKET 3X3
FOOTBALL
HANDBALL
HOCKEY EN SALLE
RUGBY
VOLLEY-BALL
NOM
*
Your answer
PRENOM
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Your answer
DATE DE NAISSANCE
*
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ADRESSE COMPLETE
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NUMERO,RUE,CODE POSTAL,ET VILLE
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TELEPHONE PORTABLE
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E-mail
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MOYEN DE LOCOMOTION
*
véhicule personnel
transport en commun
Required
SECTEUR D'INTERVENTION POSSIBLE
*
POSSIBILITE DE COCHER PLUSIEURS CASES
VALENCIENNOIS
DOUAISIS
LITTORAL
METROPOLE LILLOISE
Required
N° de Licence Fédéral
*
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Club Fédéral
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NIVEAU ACTUEL D'ARBITRAGE
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CUA 1 (Diplôme Universitaire)
CUA 2 (Diplôme Universitaire)
CUA 3 (Diplôme Universitaire)
DIPLOME FEDERAL
AUCUN
SI DIPLOME FEDERAL INDIQUER LE NIVEAU (Ex : Départemental - Régional - National)
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DISPONIBILITE DU JEUDI APRES MIDI (Indiquer les horaires)
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DISPONIBILITE EVENTUELLE LE SOIR EN SEMAINE
METTRE LE JOUR ET LES HORAIRES
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OBSERVATIONS EVENTUELLES
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