Referee Course Registration Form 2012

Soccer Parents: We need your help in volunteering to ensure our kids can play games. Please help by volunteering to be a referee. Please sign up for one of the classes listed below.

If you have questions, please contact Paul Harmenzon, Director of Referee Instruction, at paul_harmenzon@phmsa.org.

First Name
Last Name
Address
City
Zip
Home Phone
Work Phone
Mobile Phone
Email 1
Email 2
Are you a youth referee volunteer (under 18)? Yes.

Class Location Date/Time
Basic(U10) Referee Class
New Referees		 Concord Bible Church
Concord Bible Church
Concord Bible Church		 Mon, 01/09/2012, 5:30pm to 9:00pm
Fri, 01/13/2012, 5:30pm to 9:00pm
Sat, 01/14/2012, 8:00 am-12:00 pm
Intermediate Referee Class
Upgrade from Regional		 VFW
VFW
PHMS Field		 Tue 2/21/2012, 6:45 to 9:45
Wed 02/22/2012, 6:45 to 9:45 <-- Change
Sun 02/26/2012, 8:00 am-2:00 pm
Advanced Referee Class
Upgrade from Intermediate		 VFW
TBD
PHMS Field		 Tue 3/6/2012, 6:45 to 9:45
Thu 3/8/2012, 6:45 to 9:45
Sun 3/11/2012, 8:00 am-2:00 pm

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