NSWRL 2010 ALL SCHOOLS KNOCK-OUT
REFEREE – APPLICATION FORM
DATES: 2nd, 3rd & 4th AUGUST 2010

NAME:___________________________________

ADDRESS:________________________________

SUBURB:__________________________________-

POSTCODE:____________

CONTACT NUMBERS:

HOME:_________________

MOBILE:_________________

EMAIL ADDRESS:________________________

DISTRICT CLUB / CRL GROUP:_______________________________________________

I am AVAILABLE to assist:

Monday 2nd Aug [  ] Tuesday 3rd Aug [  ] Wednesday 4th Aug [  ]

I am qualified to referee:

Mini [  ] Mod [  ] International [  ]

Level of refereeing qualification:

Level 1 [  ] Level 2 [  ] Level 3 [  ]

EXPERIENCE: ______________________________________________________________________________

Association Approval Required: PRESIDENT/SECRETARY: ________________________________________

Age Group recommended: - By Local District Coaching Director / Appointee: ____________________

Signature: ____________________________________________________________________

Applicants Signature: _______________________________________________________________________

Clothing Size: please circle:  S    M    L   XL    XXL

Please return completed form by Friday 9th July 2010
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Post: PO Box 3180 Rhodes 2138
Fax: 02 8732 1609