Western New York State Referees Association
Entry Level Referee Course Registration Form
Select the course you wish to attend:
Select One
Entry Level Class, Bath starts May 2
Personal Data
Name:
Address:
City:
State:
Zip:
Phone Number(s):
Email Address:
Date of Birth:
(Use the format m/d/yyyy!)
Gender:
Select One
Male
Female
Will you be 18 years of age or older on May 1, 2008?
Select One
Yes
No
If yes to above,
do you have a valid NYSWYSA Risk Management Pass?
Select One
Yes
No
Please Note:
Once you click the submit button, the instructor or DRA will contact you to tell you how much your check needs to be made out for, whom to make it out to and where to mail it.