Referee Registration Form

BAROSSA BASKETBALL

BAROSSA VALLEY AMATEUR BASKETBALL ASSOCIATION INC

ABN 33490096872

PO BOX 267 NURIOOTPA SA 5355

Message Centre (08) 85633111

Home Page www.barossa.basketball.net.au

E-mail bvaba@bigpond.net.au

 

 

REFEREE REGISTRATION FORM

NAME                                                                       

 

ADDRESS

 

EMAIL

 

HOME PHONE NO

WORK PHONE NO

 

MOBILE NO

 

DATE OF BIRTH                  /           /

 

REFEREE QUALIFICATION LEVEL                                LEVEL

 

MODULES COMPLETED

 

DATE HIGHEST QUALIFICATION ACHIEVED                        /           /

 

PREFERRED NIGHTS FOR REFEREEING GAMES

 

PREFERRED TIMES  FOR  REFEREEING GAMES

 

IF YOU ARE A PLAYER, WHAT TEAM AND AGE GROUP?

 

IF YOU ARE A COACH, WHAT TEAM AND AGE GROUP?

 

HAVE YOU READ THE BAROSSA BASKETBALL CODE OF BEHAVIOR FOR

OFFICIALS AND THE ASSOCIATION BY-LAWS?                   YES    [   ]       NO   [   ]

 

IF NO, PLEASE DO SO. THESE ARE AVAILABLE AT THE WEBSITE www.barossa.basketball.net.au or on request from the RIC. ALL REFEREES ARE REQUIRED TO BE FAMILIAR WITH THESE.

 

Should your availability or preferences change during the season please let Anita Steinert (85623003) know for Tuesdays, Anne Brown (85621838) for Wednesdays and Thursdays) and (Bob Rochford 85633239) for Mondays.

 

 

……………………………..              ……………………………..              /           /

PRINT FULL NAME                      SIGNATURE                                    Date

Turn your favourite sports memories into

A FREE NFT!

Use code: GAMEDAY

GameDay Splash Screen