NCSRA Registration Form for Assignor Arbiter Registration for

USSF North Carolina Arbiter System

 

This form is for use by currently licensed USSF/NCSRA Assignors to register with NCSRA to be added to the USSF North Carolina arbiter statewide assigning system.  In order to receive an activated license to use this system you MUST do two things and we hope you will do a third.  The first requirement is that you fill out and submit this form COMPLETELY and then you must send a check in the amount of $50.00 to NCSRA c/o John Bouda, SRA, 138 Old Haw Creek Rd, Asheville, NC 28805.  The third important but not mandatory step is to attend one of our free arbiter assignor usage training clinics before the Fall season.  (The $50.00 fee will cover usage through 12/31/05.  The Assignor registration fee for 2006, including arbiter usage license, will be $100.00).

 

Assignor Contact Information:

First Name
Last Name
Address
City
State
Zip/Postal Code
Work Phone
Home Phone
Cell Phone
E-mail

Association or Leagues you assign or plan to assign:

1-Name
2-Name
3-Name
4-Name
5-Name
6-Name
7-Name
8-Name

Site or Field Complexes you use in scheduling games (for multi-field complex just list the site, not each field. The address, city and zip code is REQUIRED):

1-Site Number of Fields
Address Zip Code
2-Site Number of Fields
Address Zip Code
3-Site Number of Fields
Address Zip Code
4-Site Number of Fields
Address Zip Code
5-Site Number of Fields
Address Zip Code
6-Site Number of Fields
Address Zip Code
7-Site Number of Fields
Address Zip Code
8-Site Number of Fields
Address Zip Code
9-Site Number of Fields
Address Zip Code
10-Site Number of Fields
Address Zip Code

Levels you assign (Click Yes to any you do assign):

Professional :  Yes     No 
PDL:  Yes     No 
W-League  Yes     No 
1st Division Adult Men:  Yes     No 
1st Division Adult Women:  Yes     No 
U-23 Adult Men:  Yes     No 
U-23 Adult Women:  Yes     No 
Over 30 & Up Men:  Yes     No 
Over 30 &Up Women:  Yes     No 
Adult Men:  Yes     No 
Adult Women:  Yes     No 
Co-ed Adult Rec:  Yes     No 
Youth Classic:  Yes     No 
Youth Challenge:  Yes     No 
Youth Rec:  Yes     No 
Others:

Once the form is complete please press submit below, but not more than once!!

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Revised: 06/23/05