Interstate Student Official Nomination

Interstate Student Umpires, Referees, Officials Nomination Form

"*" indicates required fields

Name*

First Last

Date of Birth*

Gender*

Female

Male

Email*

Enter Email Confirm Email

Mobile Number*

Full School Name*

Polo Shirt Size*

Name*

First Last

Relationship*

Contact Number

Email*

Enter Email Confirm Email

Please Select The Championship You Are Nominating For:*

Do You Wish To Be Considered For Another Championship?

Yes

Please Select The Second Championship You Are Nominating For:*

Current Umpiring Competition*

Current Umpire Coach*

Coach Contact Number*

Umpire Accreditation Level*

School Notification*

I understand it is a parent/student responsibility to notify the school of this nomination.

This field is for validation purposes and should be left unchanged.