BENDIGO TECHNICAL OFFICIALS GROUP - Referee Availability Form Summer Season 2017/18
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Email *
Your answer
Address *
Your answer
Phone Number *
Your answer
Next of KIN, Relationship, and Contact Number *
Example: John Smith, Father, 0469030000
Your answer
Is there any medical conditions the TOG need to be aware of?
Leave blank if none
Your answer
Are you an ambulance member? *
Does the TOG have your permission to call an ambulance for you if the need arises? *
Working with children check (Referees over 18)
Please provide your card number and expiry date below. This must be completed for Referees over the age of 18
Your answer
Referee Grade *
If you play, please list down what night(s), which team(s) and division(s) you play in
Your answer
Sunday Nights
Monday Nights (Outside Venues will be used)
Tuesday Nights
Wednesday Nights
Friday Nights (Outside Venues will be used)
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