Interstate Umpire Nomination Form 2012

**Enter your details and press submit at the bottom of page**

School Details:

School Name:

School Contact Person:

Email:

Umpire Nominating:

Surname:   First:   DOB:

Address:   Suburb:

Post Code:   Email Address:

Phone:   Mobile No:

Current Umpiring Competition:   Coach contact Number: 

Current Umpire Coach:   Umpire Accreditation Level:

 Type of Umpire [Field, Goal or Boundary]:

Umpires nominating will be invited to the trial days to officiate [see timeline for dates].  Permission will be required from your school to attend.  Information will be emailed to applicants.

Principal Authority:

A condition of participation is schools compliance with DET Policies and Guidelines as they relate to excursions.  My school Principal has sighted the State Trials Principal and Parent Information and endorses this nomination.  Yes (Please click)

Parent Authority:

My parents are aware of, and endorse my nomination:  Yes (Please click) 

I wish to be considered for selection for State School Football Umpiring to participate in the School Sport Australia AFL Championship in July and agree to abide by the decisions of the selectors.    (Please Click)

When you submit this form it will automatically be emailed to:

Peter Smith School Sport WA Phone:   9264 5770

[All players will be contacted by post or email. A school and parent permission form will be posted to the player.  A signed copy of this form is to be presented on the day of the trial]