First name:
Middle initial:
Last name:
Personal title:	Select Mr. Ms. Mrs. Miss
Date of Birth:	yyyy/mm/dd
Height:
Weight:
Education:
Occupation:
Street address:
City:
State/province:
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Home phone:
Home FAX phone:
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Email:
District:
Hockey Experience as a player if:	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Highest Level you played:	Select Squirt Pee-Wee Bantam Midget Junior Pro
Organization:
Years of Officiating:	Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Current Level:	Select 1 2 3 4 5 6
Highest worked as a referee:	Select Squirt Pee wee Bantam Midget Junior Pro
Highest worked as a linesman:	Select Squirt Pee wee Bantam Midget Junior Pro
Profesional Experience: (Provide all professional and junior hockey experiences you have gained as either a linesman or referee.)
Training: (Provide names of schools or USA Hockey Camp you have attended in addition to the year you attended CRS.)
State your officiating career goals:
State your goals and expectations for the camp
Current Area Supervisor:
CRS Camp attended:	1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 CTRL + Click (multiple selections)
Note:
How did you hear about us?

Spaces are limited Registration Fee:$295.00 Power Skating Class Add $40.00 to your fee(optional) Confirmation letter will be send to you after receiving your registration form and full payment. After you submit your registration, we need your payment 7 days following your submission, otherwise your place at the school will not be saved. Register Early! All participants are required to have full officiating equipment each day. Upon receipt of FULL payment, California Referee School will confirm your camp acceptance by mail. A camp itinerary will be included at this time. Cancellations - A full refund shall be issued if cancellation is at least thirty days prior to the start of the school. In the case of a cancellation within thirty days of the start of the school, you will be refunded your payment, less an non-refundable $50.00 cancellation fee . Detrimental Conduct- California Referee School reserves the right to remove any participant from the camp due to conduct considered to be detrimental to the camp and/or its other participants. Any participant that has been removed under this policy shall not qualify for any reimbursement or refunds under any circumstances, ($25.00 Fee for returned checks).

I m Agree with term Yes No

All checks and money orders should be made payable to:

Southwest Hockey Officials Group
11818 Riverside Drive #123
North Hollywood, CA 91607