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2024 Northeast Regional Championships -- Referee Application
1
Complete Form
2
Payment
3
Confirmation
Option:
--Select--
Referee
Price:
$0.00
Description:
Jan. 12-15, Starland Sports Complex, Hanover, Mass.
= Required Field
Referee Information
--Select Player--
GENDER
Please select...
Male
Female
CITY
STATE
--Select--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NF
NT
NS
NU
ON
PE
QC
SK
YT
DATE OF BIRTH
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AGE GROUP
('23-'24)
Please select...
U14 (2010)
U18 (2006)
Adult
Mobile
SHIRT SIZE
--Select--
YL
AS
AM
AL
AXL
AXXL
Years as a U.S. Soccer licensed futsal referee
Current futsal assignor/s
Above-named assignor email address/es
Eldest/highest futsal level regularly officiated?
Did someone invite/recommend you? If so, whom?
Do you request housing?
--Select
Yes
No
Will you be available Friday 1/12?
--Select
Yes
No
Will you be available Saturday 1/13?
--Select
Yes
No
Will you be available Sunday 1/14?
--Select
Yes
No
Will you be available Monday 1/15?
--Select
Yes
No
Please Confirm
I, the referee or the parent/guardian of the above named referee, hereby grants to U.S. Youth Futsal and the Massachusetts Futsal Association, the right and permission, free from approval, review or cost, to photograph, record or otherwise capture the Referees likeness in participating in the Programs for use in media, now or hereafter known, including, but not limited to pictures and video, to copyright the same in its own name, and which may be included in whole or in part for commercial or promotional use.
By clicking in the adjacent box I hereby certify that I am an active futsal referee, currently officiating in a U.S. Soccer Federation-sanctioned futsal league (as indicated above). I am also current on my futsal referee certification, meaning that I either possess or am waiting for the arrival of a 2024 U.S. Soccer futsal referee badge (or will be taking the 2024 recertification soon).
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