2019 MRDA North America Playoffs - Rome NY - Officials Application
Tournament Head Referee, Tournament Head NSO, and Apprentice, Applications due by April 29th 2019, midnight EST.
Crew Head Referee and Crew Head NSO Applications due by May 13th 2019, midnight EST.

All other applications due by May 20th 2019, midnight EST.

Thanks for your interest in officiating at MRDA 2019 North America Playoffs hosted by Mohawk Valley Roller Derby, which will take place at the John F Kennedy Civic Arena (500 W Embargo St, Rome, NY 13440) New York, USA on 17-18 August 2019. By applying for this event, you agree to be present at the Officials' meeting and the entirety of the event.

This two-day, single-track event, will feature the top 8 ranked North American/Australasian MRDA teams, as determined by the MRDA. All games will be sanctioned. Please fill out the form below to apply.

Please check that you have the available time off from work/family and funds to participate in this event before you apply. Applying does not mean that you have been accepted.

If you have additional questions, email playoffs@mrda.org

Thank you!

Legal Name *
Your answer
Derby Name
Your answer
Email address *
Your answer
League Affiliation
Your answer
Affiliated league's parent organization *
Link to game history: *
Please submit your game history in the standard "WFTDA Official's Game History" format. If you need the template, it is available at the bottom of the page here: http://wftda.org/officiating
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Are you an MRDA recognized official? *
Are you a WFTDA/MRDA certified NSO? *
Are you a WFTDA/MRDA certified SO? *
Do you have any NSO / SO Certification Endorsements? *
Required
Insurance number / Provider *
Example: 12345 / WFTDA
Your answer
What position are you applying for? *
Are you interested in being a Tournament Head? *
Are you interested in being a Tournament Head Apprentice? *
Are you interested in being a Crew Head? *
Required
What positions are you applying for / capable of performing? *
Required
If there is anything we need to know, such as an allergy or emergent medical condition or a position you are unable to work (due to physical or other limitations), please let us know.
Your answer
References
Please list three people who can speak to your qualifications as an official.
Reference 1 Name *
Your answer
Reference 1 Email *
Your answer
Reference 2 Name *
Your answer
Reference 2 Email *
Your answer
Reference 3 Name *
Your answer
Reference 3 Email *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Men's Roller Derby Association. Report Abuse - Terms of Service