Interstate Student Official Nomination

Interstate Student Umpires, Referees, Officials Nomination Form

"*" indicates required fields

Phone

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

Student Details

Name*

First Last

Date of Birth*

Gender*

Female

Male

Email*

Enter Email Confirm Email

Mobile Number*

Full School Name*

Polo Shirt Size*

Parent/Guardian Details

Name*

First Last

Relationship*

Contact Number

This field is hidden when viewing the form

Contact Number

Email*

Enter Email Confirm Email

Umpiring Specific Details

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*

Number of Years of Experience*

School Notification*

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

Interstate Student Umpires, Referees, Officials Nomination Form

Student Details

Parent/Guardian Details

Umpiring Specific Details

Contact us

phone

(08) 6285 6050

ADDRESS

TUART COLLEGE - 105 BANKSIA STREET, TUART HILL WA 6060

(ROOM A3 - HODGSON STREET ENTRANCE)

E-mail

[email protected]