Club Referee Expression of Interest
***** If you were active as a Club Referee in 2018, do NOT complete this form !!!

Club Referees are needed whenever FFA-certified Referees are not available for our home games. We also appoint qualified Club Referees to most smaller field games (U8-U12). To qualify as a Club Referee, you must be 12 or older and attend an instruction course. Please register your interest by completing the Form below. If you will be aged 17 or younger during any part of the season ahead, an adult's details are also REQUIRED: the adult will be copied on all emails sent to the Referee.

Instruction courses are offered during Jan-Mar. Even with no prior experience, this coaching should leave you feeling reasonably confident to perform well as a Referee at your very first match. Adults are VERY welcome to register and we would also like to increase our number of female Club Referees. All Referees are supported with regular mentoring.

If you wish to become an FFA certified Referee and so become eligible for games at other Clubs as well as your own, you can get more information and register for a course at www.FootballQueensland.com.au via the Referees tab.

Please send this form to anyone else interested in Reffing. If you have any questions, email: ClubRef@GMX.us
Chris Appleton, Referee Coordinator

Referee First Name Last name *
Your answer
Referee's email (It is better for young Referees to receive information directly) *
Your answer
Ref's PERSONAL cell - ONLY for game day urgency. Type with spaces and NO brackets in this format: 0423 456 789 Do NOT leave out spaces !!!! *
Your answer
DOB - Only if U18 in 2018, your DOB (+ all marked ** below)
MM
/
DD
/
YYYY
Adult first name** (Do NOT include surname)
Your answer
Adult cell** - ONLY for game day urgency. Type with spaces and NO brackets in this format: 0423 456 789
Your answer
Adult email(s)**: Separate each with a semi-colon ( ; ) (All will be copied on every email sent to U18 Referee)
Your answer
Playing experience (if any) + Football Club you are most closely associated with [Just put "X yrs", "Club"]
Your answer
Referee experience (if any) incl any certification + where/when obtained
Your answer
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