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Referee Certification

(Renewing referees register at Re-Certification.)
* required
   
* Clinic Location:
Check if Home Study (requires special approval)
* Date:
* First Name:
* Last Name:
* I am:
* Date of Birth:
Indoor Referee Since: (year)   Grade:
* Billing Address:
* City:
* State:
* Zip:
Country:
* Telephone:  
* Email:
Check if you wish to be removed from USIndoor's public directory:
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2.
   
Order your Official USIndoor Referee T-Shirt
Color: Size: Quantity:
Black
Exclusively available to USIndoor certified referees
Gilden 100% Ultra Cotten
$12.95 (price includes shipping)
   
   
 
WAIVER: 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.
 
BILLING NOTICE: A $60 certification charge will be made on your credit card. Fee includes Official Rulebook, USIndoor Badge, general liability insurance, excess medical coverage and subscription to USIndoor's GOAL Online (t-shirt order is extra.) This form can be printed and mailed to the address below, if paying by check. Please make check payable to: "United States Indoor Soccer Association." Sorry, NO REFUNDS.

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Indoor Soccer Referee Certification

United States Indoor Sports 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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