2018 Age Group Long Course Championship
Answers marked with a * are required.
 
1. First Name: *
 
 
 
2. Last Name: *
 
 
 
3. E-Mail Address: *
 
 
 
4. Wireless Phone #: *
 
 
 
5. LSC: *
 
 
 
6. Background Check and Athlete Protection up to date?
  Yes No
Background Check
Athlete Protection
 
 
 
7. I will work all sessions: *
 
 
 
8. If not all sessions, please indicate what sessions you can work:
 
 
 
9. Please select your current highest certification as an official in each position.
  None LSC N2 N3
AO
S&T
CJ
STR
DR
Ad R
 
 
 
10. What position would you like to be considered for (pick two)?
  Any AO S&T CJ STR DR AD Ref
1st Choice
2nd Choice
 
 
 
11. If offered, your preferred shirt size (prioritization goes to officials working all sessions).
  S M L XL 2XL 3XL
Men's
Women's
 
 
 
12. If available, request for an evaluation (select one).
  None N2 N3i N3 (S&T only) Not Sure
AO
S&T
CJ
STR
DR
AR
 
 
 
13. Most recent evaluation, date and evaluator name:
 
 
 
 
 

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