2013 Honky Tonk Stomp Officiating Application
Application Deadline for Tournament Head Referee and Crew Head Referees/NSOs: 2/15/13
Application Deadline for all other positions: 3/31/13

Event Dates: June 22-23
Event Location: Appalachian Fairgrounds, 100 Lakeview Street, Gray, TN 37615

Questions regarding the event or this application may be addressed to stompofficials@gmail.com.

Tournament Head Referee will be announced by: 2/28/13
Crew Head Referee/NSO positions will be announced by: 3/14/13
All other positions will be invited by: 5/2/13

Please fill out this form completely. Applicants may use one single form submission to apply for any or all positions (referee and nso). Application does not guarantee placement.
Derby Name *
Your answer
Legal Name *
Your answer
League Affiliation *
Your answer
Referee Position(s) Applying For
Are you willing to referee Junior Roller Derby (using full, current WFTDA rules)?
WFTDA Referee Certification
NSO Position(s) Applying For
WFTDA NSO Certification
Officiating Resumé *
Please provide a link to your online (Google Doc) officiating resumé. If you do not have one available online, you may email your resumé to stompofficials@gmail.com and enter the word "email" in the box below.
Your answer
What days are you willing to work? *
Additional Information
Feel free to provide any additional information regarding your experience that may help us place you in this event.
Your answer
Email Address *
Your answer
Phone Number *
Your answer
WFTDA Insurance Number *
Your answer
Emergency Contact Name & Phone Number *
Your answer
Medical Conditions / Allergies *
Your answer
Do you understand all bouts will be played under the current WFTDA Rules? *
Do you understand you must wear all safety equipment required by the WFTDA Rules and Safety Protocol? *
If selected do you agree to work your assigned position for the assigned timeframe, attend all meetings and perform to the best of your abilities? *
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