WASA
PO Box 2484
Westerville, OH 43086

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Referee Information Form

Note, you must be at least 12 years old to become a referee.

Contact Information

First:		Last:
Street:
City:		Zip:
Phone:	(H)		(C)
Email:

USSF Information

USSF Number:		Don't have USSF number
USSF Grade:	1 - USSF Internatiional Refreee 2 - USSF International Asst. Referee 3 - USSF National Referee (Intl. Cand.) 4 - USSF National Referee 5 - USSF State Referee Class 1 6 - USSF State Referee Class 2 7 - USSF Referee Class 1 8 - USSF Referee Class 2 9 - USSF Recreational Referee 10 - USSF Linesman 11 - USSF Associate Referee	Year Certified:

Are you 18 or over? Yes No

 

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