Referee Clinic Registration

(New Certifications Only – Re-Certifying USIndoor referees please click here).

Clinic Location:    Date:
         or Home Study:

First Name:    Last Name:

Select :     DOB:

Indoor Referee Since: USSF Grade:

Address:

City: State: Zip:

Telephone: (Day) (Evening)

E-mail Address:

Mark if you wish to remove your name from USIndoor's public directory

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should be?

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  Order Your USIndoor Referee T-Shirt
Exclusively available to USIndoor certified referees
$12.95 (price includes shipping)
Color:
Black

 

Size:
Quantity:
  Gilden 100% Ultra Cotten


By applying hereby or submitting payment herewith for referee certification, I acknowledge and accept its inherent risks and agree to hold USIndoor harmless from any liability or claim by or against me (or my minor child, in my capacity of parent or guardian, if applicable) for personal injuries or property damage relating to my (or such child’s) training or services as a USIndoor certified referee.

NOTE: A $60.00 charge will be made on your credit card. Fee includes Official Rulebook, USIndoor Badge, general liability insurance, excess medical coverage and subscription to USIndoor Referee Newsletter. (See Referee Page for more details.) This form can be printed, completed and mailed to the address below, if paying by check. Please make check payable to: United States Indoor Soccer Association. Sorry NO REFUNDS.



United States Indoor Soccer Association,
1340 N. Great Neck Road, Suite 1272-142 | Virginia Beach, VA 23454-2268
Fax: (509) 357-7096 | Email:
pr@usindoor.com
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