Limestone Coast Referee Education Weekend - 18 - 20 July
Expression of Interest Form
Name
*
First Name
Last Name
Parent/Caregivers Name (If under 18 years old)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Date Of Birth
*
DD/MM/YYYY
Which session would you like to register interest in (multiple can be selected)
*
Introductory Referee Course: Friday 18 July 6:00pm (Naracoorte)
Introductory Referee Course: Saturday 19 July 9:00am (Apollo SC)
Club/Referee Roadshow Session: Saturday 19 July 4:00pm (Gambier Centrals SC)
Referee Coach/Mentor Training - Online - Date TBC
Seeking general information on refereeing
Are you involved/affiliated to a Club or the Association?
*
Please Select
Apollo
Blue Lake
Centrals
Inter
Millicent
Naracoorte
Portland
LCFA (Association)
LCFRA (Referees)
No Affiliation
Other
If yes, what is your role at the club?
Example: Player, parent, volunteer, supporter, coach.
Do you currently hold any referee accreditation
Please Select
Yes
No
If yes, please provide details of accreditation level and year
Do you currently hold a DCSI Working With Children Check (WWCC)?
Please Select
Yes
No
Application pending
Submit
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