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NCSRA Registration Form for Out of State USSF Referees Officiating at

North Carolina USSF Tournaments

This form is for use by currently registered USSF Referees from states other than North Carolina who wish to referee at North Carolina USSF tournaments. NCSRA asks all out of state referees to complete and submit this form only once within any calendar year so that we may add you to our statewide assigning database. This will allow all of our assignors handling tournaments to assign you and will allow you to receive invitations from and sign up for future tournaments within North Carolina that are held in the same calendar year. Once the form is completed and submitted it will be sent directly to NCSRA and your information will be added to the USSF North Carolina Arbiter group. Your information will remain in that group for the remainder of the calendar year.

Please provide the following contact information:

First Name

Last Name

Address

Address (cont.)

City

State

Zip/Postal Code

Work Phone

Home Phone

Cell Phone

E-mail

Present Referee Grade

Date of Birth

SSN (Required for payment purposes)

Approx. 1^st Date of USSF Registration

Approx. Date attained present grade

USSF ID# (if known)

Gender

Present State Association

Primary Assignor’s Name

Primary Assignor’s Phone #

Primary Assignor’s Email Address

Highest Regular Referee Assignment Levels (be honest!)

Highest Division you regularly work

Highest level assigned regularly as center referee

Highest level assigned regularly as assistant referee

Are you an Assessor as well?

If so, what is your present assessor grade?

Would you like assignments as an assessor if available? Yes No

USSF regulations require that referees officiating outside of their home state association have the permission of their state referee administration. By submitting this registration you acknowledge that you are in good standing with USSF and have permission from your state referee administration to officiate outside of your home state, in particular, North Carolina.

Thank you for your submission. After pressing submit below, you should receive an arbiter welcome message within about two weeks. Instructions on accessing the arbiter can be found on the NCSRA web page at www.ncsra.org. The arbiter log in is located at www.thearbiter.net.

First Name
Last Name
Address
Address (cont.)
City
State
Zip/Postal Code
Work Phone
Home Phone
Cell Phone
E-mail
Present Referee Grade
Date of Birth
SSN (Required for payment purposes)
Approx. 1^st Date of USSF Registration
Approx. Date attained present grade
USSF ID# (if known)
Gender
Present State Association
Primary Assignor’s Name
Primary Assignor’s Phone #
Primary Assignor’s Email Address
Highest Regular Referee Assignment Levels (be honest!)
Highest Division you regularly work
Highest level assigned regularly as center referee
Highest level assigned regularly as assistant referee
Are you an Assessor as well?
If so, what is your present assessor grade?
Would you like assignments as an assessor if available?	Yes No

Copyright © 2005 www.ncsra.org. All rights reserved. Revised: 06/28/05

Copyright © 2005 www.ncsra.org. All rights reserved.
Revised: 06/28/05