N. E. U. R. A. Registration Form 2020 / 2021

1

Referees Under the age of 18.
Referees under the age of 18 can only referee youth football. They will be contacted by the Youth leagues to referee in their Leagues. Please complete this form to register with NEURA. You can NOT referee in a youth league without registering with NEURA first.
South Belfast Youth Football League.
Lisburn Invitational Youth league.
NIFL Youth League.

2

Are you Over 18 years of Age?If under 18 years of age at time of registering you will only be able to referee Youth Football.

YESNO

3

This part to be completed by the Parent or Guardian of the Referee aged under 18.By completing this part you give NEURA and other affiliated refereeing body's Permission to contact the referee regarding refereeing allocations and training.

Parent or Guardians First Name

Parent or Guardians Last Name

4

Parent or Guardian contact Number.if you don't use a Mobile please enter contact number.

Please enter a valid contact number.

5

Parent or Guardian EmailEmail Address of Parent or guardian of the Referee aged Under 18 at time of registering

example@example.com

6

Referee's Email AddressEmail Address of the Referee aged Under 18 at time of registering

example@example.com

7

I accept that my details may be shared with the Irish Football Association.“ In registering with N.E.U.R.A. your email address and other details may be shared with Comet. Comet is the trading name for the new Football Management System which the Association has started introducing in the 18/19 football season . The Football Management System is for the internal use by the IFA and its members for the sole purpose of improving the administration of football in Northern Ireland”. Also the Northern Ireland referee's Association and County Antrim Football Association.

I accept that my details mat be shared with the Irish Football association, Also NIRA and CAFA

8

Signature of Parent or GuardianBy signing this you give permission to NEURA and other affiliated refereeing body's Permission to contact the referee regarding refereeing allocations and training.

Clear

9

Referee's Name

First Name

Last Name

10

Referee's Email AddressPlease supply a valid email address

example@example.com

11

Number of years Refereeingif new referee, please enter 0

Please enter number of years refereeing.

12

Referee's Address:Please enter your full address with post code.

Street Address

Street Address Line 2

City

Post Code

Country

13

Mobile Numberif you don't use a Mobile please enter contact number.

Please enter a contact Number.

14

Date of BirthPlease Supply your Date of Birth

Date

15

NEURA Constitution
Please read the NEURA Constitution below and accept that you have read and understood it.

16

Please Read the North East Ulster Referee's Association Constitution.

17

Confirmation that you have read the NEURA Constitution.* This field is required.

I have read, understood, and accepted the rules of the NEURA Constitution.

18

I accept that my details may be shared with the Irish Football association.* This field is required.“ In registering with N.E.U.R.A. your email address and other details may be shared with Comet. Comet is the trading name for the new Football Management System which the Association has started introducing in the 18/19 football season . The Football Management System is for the internal use by the IFA and its members for the sole purpose of improving the administration of football in Northern Ireland”. .

I accept that my details mat be shared with the Irish Football association.

19

It is Compulsory to Agree with the Comet Sharing protocols.* This field is required.“ In registering with N.E.U.R.A. your email address and other details may be shared with Comet. Comet is the trading name for the new Football Management System which the Association has started introducing in the 18/19 football season . The Football Management System is for the internal use by the IFA and its members for the sole purpose of improving the administration of football in Northern Ireland”. .

I have read, understood, and, Agree with the Comet Sharing protocols

20

Registration FEE's for 2020/2021 Season

Premier League £90.00
Premier League Assistants £60.00
Senior £60.00
Senior Assistants £45.00
PIL £45.00
PIL Assistants £40.00
Intermediate £45.00
Junior £40.00
Associate £27.50 (ALL Youth Football Only)
Club £40.00
Observer / Retired £20.00

21

If your registration is as a Club Referee, please state your club.Please enter your Club's Team

22

Please select your Grade for season 2020 / 2021Please select Grade for season 2020 / 2021 (if you dont know your grade use last years)

Please select, one option Only.

23

Please select Junior, Retired or Grade above Junior IF you are a graded above Junior please click on Button Below.

JUNIOR ACTIVE /Retired, Observers ,Club Referee and Associate RefereeGrade Above Junior. ie Premier, PIL, Senior, Intermediate and above,. etc.

24

Junior ‘active’ referee? IF you are a Junior ‘active’ referee please complete the next two questions and click on Junior Active referees. Referees affiliated as, Associate, Retired, Observers and Club Referees click on button below.

JUNIOR ACTIVERetired, Observers ,Club Referee and Associate Referee

25

Which Junior League where you allocated to last Season 2019/2020Please select Allocation for season 2019/2020

Please select, one option Only.

26

Please indicate which Junior league preference for 2020/2021It is the County Antrim Football Association Co-ordinator who appoints junior referees to leagues.

Please select, one option Only.

27

I accept that my details mat be shared with the Irish Football Association (IFA), The County Antrim Football Association (CAFA) and Northern Ireland Referee's Association (NIRA).* This field is required.“ In registering with N.E.U.R.A. your email address and other details may be shared with Irish Football association and the County Antrim Football Association (CAFA) and (NIRA) The Football Associations will use this information for the sole purpose of improving the administration of football in Northern Ireland.

I accept that my details mat be shared with the CAFA, NIRA and IFA.

28

Referee Signature RequiredBy signing this you give permission to NEURA and other affiliated refereeing body's Permission to contact the you regarding refereeing allocations and training. You also agree that the information you have submitted is true to the best of your Knowledge.

Clear

29

Please verify that you are human* This field is required.

30

How to Pay your registration FEEClick on Button for details on how to pay.

Paying by Bank TransferPaying by Cheque.

31

Registration FEE's for 2020/2021 Season

Paying By Bank Transfer

Log on to your online banking and transfer your fee to NEURA.

Bank Transfer to Danske Bank.

Danske Bank Sort Code : 95-01-28
Danske Bank Account number 40097217

You must use the narrative on bank transfer form.
Please enter your Full Name and REG.

ie. JOE BLOGS REG

32

Cheques are made payable to:

"North East Ulster Referees Association"·

Send a cheque to;

Lawrence Black, 66 Alliance Road, Belfast 14, BT14 7JB.

'Please do not send cash through the post, unless using special delivery'

Once you submit your application, we will contact you shortly to complete your application.
Thank you!

33

Once you submit your application, we will contact you shortly to complete your application.

Thank you!

34