2022 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. Club: *
 
 
 
7. BGC, APT and CPT up to date?
  Yes No
Background Check
Athlete Protection
Concussion Protocol Training
 
 
 
8. I will work all sessions: *
 
 
 
9. If not all sessions, please indicate what sessions you can work:


Thursday / Friday



      
 
 
 
10. If not all sessions, please indicate what sessions you can work.


Saturday


      
 
 
 
11. If not all sessions, please indicate what sessions you can work.

Sunday


      
 
 
 
12. Please select your current highest certification as an official in each position.
  None LSC N2 N3
AO
S&T
CJ
STR
DR
Ad R
 
 
 
13. What position would you like to be considered for (pick two)?
  Any AO S&T CJ STR DR AD Ref
1st Choice
2nd Choice
 
 
 
14. If offered, your preferred shirt size (prioritization goes to officials working all sessions).
  S M L XL 2XL 3XL
Men's
Women's
 
 
 
15. If available, request for an evaluation (select one).
  None N2 N3i N3f N3r Not Sure
AO
S&T
CJ
STR
DR
AR
 
 
 
16. Most recent evaluation, date and evaluator name:
 
 
 
 
 

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