2015 Omaha President's Day Reply Form
Name
*
First
Last
Address
*
City
*
State
*
Zip
*
Cell Phone
*
Home Phone
*
USAV referee certification level
*
Provisional
Regional
Junior National
National
Other (explain in Notes section)
Email
*
POLO SHIRT SIZE
*
SELECT ONE
XS
S
M
L
XL
XXL
XXXL
XXXXL
T-SHIRT SIZE
*
SELECT ONE
XS
S
M
L
XL
XXL
XXXL
XXXXL
DATES I WANT TO WORK:
Choose all that apply
*
SAT Feb 14
SUN Feb 15
MON Feb 16
Other (explain in Notes section)
I NEED A HOTEL ROOM ON:
Choose all that apply
*
FRI night Feb 13
SAT night Feb 14
SUN night Feb 15
MON night Feb 16
Other (explain in Notes section)
ROOMMATE PREFERENCE
*
DATE and TIME I WILL ARRIVE
*
DATE and TIME I WILL LEAVE
*
Tell me the date and the clinician for the 2015 USAV referee clinic you attended in your region this season:
Date
*
Clinician
*
Notes:
*
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