MRDA Officiating Clinic 2013
Registration for the MRDA Officiating Clinic 2013.

This event is a 2-day clinic that will be held Thursday 8/15 at 10 am through Friday 8/16 at 5pm.

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Clinic Dates: August 15-16, 2013
Location: JFK Civic Arena, 500 W Embargo St, Rome, NY
Host: Quadfathers Men's Roller Derby
Your Information
First Name *
Last Name *
Derby Name *
League Name *
If no home league put "IND"
Primary Phone *
(123) 000-1234
Email *
Address Line 2
Zip Code
Personal Insurance Provider and Number
ex: Navigator -- 123456789
ex: USARS - 12345
Attendance Information
Registering as: *
Do you intend to submit an application to teach at this clinic? *
Application requirements will be announced in late May.
Submission and Registration Information
Please note: Once you have submitted your registration information, you should see a confirmation message screen with details about how to finish your registration payment and other information. Your registration is not complete until payment has been received. The cost to register for this clinic is $75.
Are you a MRDA recognized official? *
Interested Topics
Please briefly list three or four topics of interest for this clinic.
Will you be applying for a microgrant to defray your registration costs?
Will you be donating additional funds to defray another participant's registration costs?
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