NEURA REG Form Season 2021/2022

1

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.

Lisburn Invitational Youth league.
NIFL Youth League.

Southbelfast Footballleague SBYFL ( YOUTH ) sbyfleague@gmail.com

National Boys League (Youth) logy2142@gmail.com

If you are a CLUB Referee, please do not fill in this form, IFA take all Club Referee registrations.

IF YOU ARE A REGISTERED PLAYER ON COMET DO NOT FILL IN THIS FORM.

email, neura.treasurer neura.treasurer@gmail.com for advice

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

{refereesName54}..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

{refereesName54}..Address:Please enter your full address with post code.

Street Address

Street Address Line 2

City

Post Code

Country

13

{refereesName54}..Mobile Numberif you don't use a Mobile please enter contact number.

Please enter a contact Number.

14

{refereesName54}..Date of BirthPlease Supply your Date of Birth

Date

15

NEURA Constitution
{refereesName54}Please read the NEURA Constitution below and accept that you have read and understood it.

16

{refereesName54}Please Read the North East Ulster Referee's Association Constitution.

17

Confirmation that you have read the NEURA Constitution.* This field is required.{refereesName54}..Please confirm

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

18

I {refereesName54} 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 2021/2022 Season

Premier League £90.00
Premier League Assistants £60.00
Senior £60.00
Senior Assistants £27.50
PIL £27.50
PIL Assistants £22.50
Intermediate £27.50
Junior £22.50
Associate £17.50
Assessors £20.00

21

13. SUBSCRIPTIONS
The Subscriptions for each member, as decided by the Annual General Meeting, shall be paid no later than 31st may each year. Late payment will incur an increase of £10, the combined total of which shall be donated to the Associations charity for the season in question.
(This stipulation will commence as of season 2017/18)

22

Please select your Grade for season 2021 / 2022{refereesName54}..Please select Grade for season 2021 / 2022 (if you don't know your grade use last years)

Please select, one option Only.

23

Confirmation that you have passed a fitness test.* This field is required.{refereesName54}..Please confirm if you have passed an IFA fitness test in the last 2 years

YES I HAVE passed an IFA fitness test in the last 2 years

NO I HAVE NOT passed an IFA fitness test in the last 2 years

24

{refereesName54} Please select Junior, Retired or Grade above Junior IF you are a graded above Junior please click on Button Below.

JUNIOR ACTIVE /Retired, Observers, and Associate RefereeGrade Above Junior, i.e. Premier, PIL, Senior, Intermediate etc.

25

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, and Associate Referee

26

Which Junior Adult League where you allocated to last Season 2020/2021Please select Allocation for season 2020/2021

Please select, one option Only.

27

Please indicate you first preference for a Junior Adult league for 2021/2022It is the County Antrim Football Association Co-ordinator who appoints junior referees to leagues.

Please select, one option Only.

28

Please indicate you Second preference for a Junior Adult league for 2021/2022It is the County Antrim Football Association Co-ordinator who appoints junior referees to leagues.

Please select, one option Only.

29

I {refereesName54} 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.

30

{refereesName54}.. Signature RequiredBy signing this you give permission to NEURA and other affiliated refereeing body's Permission to contact you regarding refereeing allocations. You also agree that the information you have submitted is true to the best of your Knowledge.

Clear

31

{refereesName54} How to Pay your registration FEEClick on Button for details on how to pay.

Paying by Bank TransferPaying by Cheque.

32

Registration FEE's for 2020/2021 Season

Paying By Bank Transfer

Log on to your online banking and transfer your fee to "North East Ulster Referees Association".

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

33

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!

34

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

35

{refereesName54} We would like to send you additional information that is relevant to you. By ticking the boxes you consent to receive information about our upcoming events, training and ways for you to get involved with the the greater refereeing community.* This field is required.Please tick at least one!

By Post

By Email

By Telephone

DO NOT SEND ME ANY non-essential circulatory emails

36

{refereesName54} You may opt out of receiving these communications at any time by emailing

N.E.U.R.A - SECRETARY secretaryofneura@gmail.com or contacting us on our web site :

http://neura.co.uk/contact.htm

We will not pass your details to third parties for marketing purposes.

37

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

Thank you!

38