Application to Officiate

Accepted officials must attend officials' briefings (one hour prior to each session) and serve at least three sessions for N2 consideration and at least four sessions for N3. The application process for National N2 and N3 Certification and Re-certification is now part of the Officials Tracking System.. This meet has been approved with Qualifying Meet number QM10-050.

First Name: Last Name:

Address: Phone:

Work Phone:

City: State Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:

E-mail address:

LSC Adirondack Allegheny Mountain Alaska Arizona Arkansas Border Central California Colorado Connecticut Florida Florida Gold Coast Georgia Gulf Hawaiian Illinois Indiana Iowa Kentucky Louisiana Lake Erie Maine Maryland Metropolitan Michigan Middle Atlantic Midwestern Minnesota Mississippi Missouri Valley Montana New England New Jersey New Mexico Niagra North Carolina North Dakota North Texas Ohio Oklahoma Oregon Ozark Pacific Pacific Northwest Potomac Valley San Diego Imperial Sierra Nevada Snake River South Carolina South Dakota South Texas Southeastern Southern California Utah Virginia West Virginia Wisconsin Wyoming

Currrent Certifications:

I will serve at all sessions: Yes No

I can serve some sessions. My choices for individual sessions are checked below:

Thursday Evening Timed Finals (4 PM)

Friday Prelims (9:00 AM) Friday Finals (6:00 PM)

Saturday Prelims (9:00 AM) Saturday Finals (6:00 PM)

Sunday Prelims (9:00 AM) Sunday Finals (6:00 PM)

Shirt Size, for host planning (not guaranteed): Size Small Medium Large X-Large XX-Large Small-Ladies Medium-Ladies

I am applying for a specific deck postion: Yes Position Anywhere Stroke/Turn Chief Judge Starter Admin. Referee Deck Referee No (If "Yes", application must be received by April 1st, 2010)

I would be willing to serve as a meet marshal before a session: Yes No

I have some specific needs or issues:

Local Officials Coordinator:

Richard Pockat

119 Beckham Court

Charlotte, NC 28211

704-458-8800