General Fact Sheet

General Fact Sheet

This page will register you with East Coast Officiating Services

Today's Date
Full Name (Last, First):
Street Address:
City:
State:
ZIP (9-digit, if known):
Home Telephone No. – (XXX) XXX-XXXX:
Work Telephone No. (XXX) XXX-XXXX, ext. XXX:
FAX Number (XXX) XXX-XXXX:
Cellular Telephone No. (XXX) XXX-XXXX:
Social Security No. (XXX-XX-XXXX) – must have ... may be transmitted via phone or mail:
Primary E-Mail Address:
Alternate E-Mail Address:
USAV or Volleyball Canada Referee Rating:	National (Canadian National)
	Junior National (Canadian Regional)
	Regional (Canadian Provençal)
	Provisional (Canadian Local)
	None
USA Volleyball Region:
PAVO Referee Rating:	National
	State
	Local
	Apprentice
	None
Shoe Size (no half sizes over 11½ ... all Asics shoes are standard width):
Men's/Women's Size?:	Men's
Men's/Women's Size?:	Women's
Shirt Size (Polo Style):	Double Extra Large
	Extra Large
	Large
	Medium
	Small
Applying for 2010 Early Bird Extravaganza (Columbus ... Presidents' Day weekend)?	Yes ... I want in
	No ... not this year
	Maybe – not sure yet
Need a hotel room for Early Bird?	Yes
Need a hotel room for Early Bird?	No
Applying for 2010 NEQ – Part I (Baltimore ... Mar. 27-29)?	Yes ... I want in
	No ... not this year
	Maybe – not sure yet
Need a hotel room for NEQ-I?	Yes
Need a hotel room for NEQ-I?	No
Applying for 2010 NEQ – Part II (Baltimore ... Apr. 2-4)?	Yes ... I want in
	No ... not this year
	Maybe – not sure yet
Need a hotel room for NEQ-II?	Yes
Need a hotel room for NEQ-II?	No
Applying for 2010 East Coast Championships (Pittsburgh ... May 29-31) ?	Yes ... I want in
	No ... not this year
	Maybe – not sure yet
Need a hotel room for ECC?	Yes
Need a hotel room for ECC?	No
Comments or Questions:

Be sure to indicate your area(s) of interest above (or in) the "Comments" box above:

– 2010 Early Bird Extravaganza ... Columbus, OH – Presidents' Day weekend

– 2010 Northeast Qualifier – Part I ... Baltimore, MD – April 2-4 (Easter weekend)

– 2010 Northeast Qualifier – Part II ... Baltimore, MD – April 9-11

– 2010 East Coast Championships ... Pittsburgh, PA – May 29-31 (Memorial Day weekend)

– Collegiate officiating – Atlantic 10 Conference, Ivy League, Patriot League, Central Atlantic Collegiate Conference, and others