DVSRA Referee Registration
Please fill out this form every year as part of your registration.
This will ensure that you are assigned to games appropriate to your level of experience.
You will be added to our mailing list.
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First name *
Last name *
Email address *
Secondary email
Phone number *
Secondary phone number *
Emergency contact person (first, last) *
Emergency contact phone number *
Birthday (Month / Day / Year)  *
Last 4 numbers of USSF ID:

 *
Current registration year:
(most recent)
Clear selection
Referee experience: years *
What is the highest level you have refereed (center)? *
Required
Referee badge: *
Other referee certifications (mentor, coach, assignor, coordinator...)
Trainings
 *
Required
WAIVER: 
I understand the risk involved in physical activity in public and do so voluntarily
 *
WAIVER:  
I agree to to follow all state, local and association guidelines regarding health and safety
 *
Comments, preferences, restrictions:
Are you interested in other roles within DVSRA?
(Board member,  instructor, referee coordinator/supervisor, mentor...)
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