2019 MRDA North America Playoffs - Rome NY

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2019 MRDA North America Playoffs - Rome NY - Officials Application

Tournament Head Referee, Tournament Head NSO, and Apprentice, Applications due by April 29th 2019, midnight EST.
Crew Head Referee and Crew Head NSO Applications due by May 13th 2019, midnight EST.

All other applications due by May 20th 2019, midnight EST.

Thanks for your interest in officiating at MRDA 2019 North America Playoffs hosted by Mohawk Valley Roller Derby, which will take place at the John F Kennedy Civic Arena (500 W Embargo St, Rome, NY 13440) New York, USA on 17-18 August 2019. By applying for this event, you agree to be present at the Officials' meeting and the entirety of the event.

This two-day, single-track event, will feature the top 8 ranked North American/Australasian MRDA teams, as determined by the MRDA. All games will be sanctioned. Please fill out the form below to apply.

Please check that you have the available time off from work/family and funds to participate in this event before you apply. Applying does not mean that you have been accepted.

If you have additional questions, email playoffs@mrda.org

Thank you!

Legal Name *

Derby Name

Email address *

League Affiliation

Affiliated league's parent organization *

WFTDA or MRDA Member

WFTDA or MRDA Apprentice/Applicant

Non-WFTDA/Non-MRDA but rule adherent

Independent - no league affiliation

Link to game history: *

Please submit your game history in the standard "WFTDA Official's Game History" format. If you need the template, it is available at the bottom of the page here: http://wftda.org/officiating

Emergency Contact Name *

Emergency Contact Phone Number *

Are you an MRDA recognized official? *

Yes

Are you a WFTDA/MRDA certified NSO? *

Level 1 NSO

Level 2 NSO

Level 3 NSO

Are you a WFTDA/MRDA certified SO? *

Level 1 Referee

Level 2 Referee

Level 3 Referee

Do you have any NSO / SO Certification Endorsements? *

Head NSO

Penalty Tracking

Penalty Management

Score and Timing

Head Referee

Jammer Referee

Inside Pack Referee

Outside Pack Referee

Required

Insurance number / Provider *

Example: 12345 / WFTDA

What position are you applying for? *

Non-Skating Official

Skating Official

Both, wherever I am needed

Both, Non-Skating Official as first preference

Both, Skating Official as first preference

Games Tournament Oversight (GTO)

Are you interested in being a Tournament Head? *

Yes, THNSO

Yes, THR

Are you interested in being a Tournament Head Apprentice? *

Yes, THNSO Apprentice

Yes, THR Apprentice

Are you interested in being a Crew Head? *

Yes, CHNSO

Yes, CHR

Required

What positions are you applying for / capable of performing? *

PBM

PBT

SBO

ALT NSO

IPR

OPR

ALT Referee

GTO Position

Required

If there is anything we need to know, such as an allergy or emergent medical condition or a position you are unable to work (due to physical or other limitations), please let us know.

References

Please list three people who can speak to your qualifications as an official.

Reference 1 Name *

Reference 1 Email *

Reference 2 Name *

Reference 2 Email *

Reference 3 Name *

Reference 3 Email *

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