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Georgia Referee Application Form
Please read the
REFEREE TESTING: REQUIREMENTS AND PROCEEDURES
State Referee or National Referee section before filling out this application form.
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Email
*
Your email
Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
USA Powerlifting Membership Number
*
Your answer
Are you a current member?
*
Yes
No
What level Referee are you applying for?
*
State
National
Cat 2
Number of Years involved in USA Powerlifting
*
Your answer
What USA Powerlifting events have you volunteered at in Georgia in the last 2 years?
*
Your answer
What volunteer position(s) did you work?
*
Your answer
Why do you want to become a State/National Referee?
Your answer
If approved by the state chair, what event and date would you like to take your exam?
*
Your answer
Please list any other experiences that will help you be a successful referee.
Your answer
Send me a copy of my responses.
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