Western New York State Referees Association
Entry Level Referee Course Registration Form
Select the course you wish to attend:
Select One
Rec Ref Only, May 29, Auburn
Personal Data
Name:
Address:
City:
State:
Zip:
Phone Number(s):
Email Address:
Date of Birth:
(Use the format m/d/yyyy!)
Age as of 5/1/2010:
Gender:
Please Select
Male
Female
Have you been previously certified as a Grade 9 or 12 referee?
Select One
Yes
No
Please Note:
Once you click the submit button, the instructor or DRA will contact you in a day or so to tell you how much your check needs to be made out for, whom to make it out to and where to mail it.
PLEASE CLICK THE SUBMIT BUTTON ONLY ONCE.
It may take up to 30 seconds to process your request.