VALLEY EXPRESS KENT YOUTH LEAGUE Referee’s Secretary Peter Grace 2 Wilson Close

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VALLEY EXPRESS KENT YOUTH LEAGUE Referee’s Secretary Peter Grace 2 Wilson Close Powered By Docstoc
					                                VALLEY EXPRESS
                               KENT YOUTH LEAGUE
                                      Referee’s Secretary:
               Peter Grace 2 Wilson Close Willesborough Leas Ashford Kent TN24 0HX
         Telephone 01233 661005 – Mobile: (07769 352944) – E-Mail pete.grace@hotmail.co.uk


    REFEREES APPLICATION FORM SEASON 2010 -2011
                       CHRISTIAN NAME                MIDDLE NAMES                 SURNAME
    FULL NAME

  FULL POSTAL ADDRESS


 TELEPHONE NUMBERS:
HOME
WORK                                                               MAY THESE BE PRINTED
MOBILE
                                                                    SELECT
EMAIL
   LEAVE A GAP BETWEEN CODE NO: AND MAIN NUMBER OR THE COMPUTER WILL DROP THE 0 BY DEFAULT


  AGE                                         LEVEL      SELECT


ARE YOU APPLYING FOR PROMOTION              SELECT       7 TO 6   SELECT       6 TO 5

 DO YOU HAVE YOUR OWN TRANSPORTSELECT

    HAVE YOU COMPLETED THE                  SELECT
  MANDATORY CRB REQUIREMENTS
                                                 READ DROP DOWN BOX (RED TRIANGLE LEFT SIDE)
    COUNTY AFFILIATION NUMBER


  I WISH TO BE INCLUDED ON THE LEAGUE’S LIST OF OFFICIALS FOR NEXT
       SEASON AND I AM AVAILABLE FOR THE FOLLOWING SUNDAYS
   1ST    2ND    3RD    4TH    5TH NB: A MINIMUM OF ONE SUNDAY PER
SUNDAY SUNDAY SUNDAY SUNDAY SUNDAY MONTH WILL BE REQUIRED TO PLACE
SELECT SELECT SELECT SELECT SELECT YOU ON THE MAIN LIST OF OFFICIALS

            WHEN ARE YOU AVAILABLE                     FROM HOME ADDRESS.                    AREA
                                                              WILLING TO COVER
SUNDAY SUNDAY SUNDAY MIDWEEK MIDWEEK                   WEST KENT SELECT      S E LONDON SELECT
  AM     PM   EVENING 6.00PM  7.30PM
SELECT     SELECT     SELECT     SELECT     SELECT     EAST KENT SELECT      DOVER/DEAL SELECT


                                                         THANET   SELECT      MEDWAY    SELECT

                                                      NORTH KENT SELECT      MAIDSTONE SELECT
                                VALLEY EXPRESS
                               KENT YOUTH LEAGUE


                                     Referee’s Secretary:
                Peter Grace 2 Wilson Close Willesborough Leas Ashford Kent TN24 0HX
          Telephone 01233 661005 – Mobile: (07769 352944) – E-Mail pete.grace@hotmail.co.uk

             REFEREES HANDBOOK SUPPLEMENT
    PLEASE RETURN THIS WITH YOUR APPLICATION FORM FOR
                  HANDBOOK PURPOSES.



FULL NAME                  0                 0                                0

FULL POSTAL ADDRESS




TELEPHONE NUMBERS: 0

HOME                       0
WORK                       0                                       MAY THESE BE PRINTED
MOBILE                     0                                                  SELECT          1
EMAIL                      0                                                                  2
                                                                                              3
                                    Statement of intent                                       4
                                                                                              5
I Agree by my signature, that I wish to be included on the referee's panel of the Kent
Youth League. In doing so I also agree to act in a manner that befits my status as a
referee and carry out all duties to the best of my ability. I will  conform to all FA,
County and League regulations and abide by the code of conduct laid out.




Electoronic Signature if
email:                                                  DATE

If by post

				
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