Referee Registration Form

Before continuing, please review the QUALIFYING REQUIREMENTS.

Congratulations on taking your first step to becoming a NYS Referee. Please fill in all required (*) fields.
Once the "Intramural Referee Coordinator" (Peter Varitimos) reviews this form, you will then be contacted by phone to confirm this information.

First & Last Name *
Street Address *
City *
Date of Birth *	eg. 01/01/1900
Guardian's Name(s) *
Home Number *	eg. (###) ###-####
Cell Number	eg. (###) ###-####
Best time to call. Check all that apply. *	Morning Afternoon Evening
Email Address *
Alternate Email
Are you now, or have you ever been involved in the NYS Soccer Program? If you have been involved in the past, explain in comments. *	Yes, I am now I was involved in the past No, I have never been involved
Comments
Are you a MSRC Certified Referee *	YES NO I'm registered in a upcoming referee class.
Current referee Level (Not School Grade)*
Why are you interested in becoming a Referee?*

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Referee Registration Form

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