2008 State and Challenge Cup Referee Registration Form

* = Required Fields

Only 2008 USSF registered referees will be selected to participate in the 2008 Indiana State Cup and Challenge Cup. This form will check the email address to see if you are in the system. If you have an EasyAssignor account please use that email address to fill out this form.
First Name	*
Last Name	*
E-Mail address	*
Address
City
State
Zip
Home Phone	*	(111-111-1111)
Cell Phone		(111-111-1111)
Work Phone		(111-111-1111)
Date of Birth	*

USSF Registration Number
USSF Grade	*	8 7 6 5 4
Number of Years at State Cup?
Number of Years at Regionals?
What is the highest level you have been the Referee?	*	(Choose U11 - Professional)
What is the highest level you have been the Assistant Referee?	*	(Choose U11 - Professional)
* Check one of the locations for the Preliminary rounds.
No Locations in the system.
You have to check every day you CAN work.
5/15/2008 (Thursday)
5/16/2008 (Friday)
5/17/2008 (Saturday)
5/18/2008 (Sunday)
(If you have specific times you can NOT work, you can adjust them once you log into EasyAssignor.)
Available for State Cup Semi & Finals to be held in Fort Wayne? Must be available for all dates (5/31/2008 - 6/1/2008)	*	Yes No
Available for Regionals? Must be available for all dates (6/20/2008 - 6/25/2008) in Rockford, IL	*	Yes No
* I confirm that I am in good physical condition and am cleared to participate in officiating at the high level of soccer that the State Cup and Challenge Cup competition requires.