SA Country Senior Championships - Referee Form- January 2023

SA Senior Country Championships Referee Form
Name

First NameLast Name
Date of Birth:

MonthDayYear
Mobile number
Email
example@example.com
Association:

Please indicate your availability for Saturday 28th January 2023: (note games may not be scheduled at all these times, we may also not be able to cater for availability requests and you may be scheduled for other games)*

	Saturday 28/01/2023 Yes Available
Morning
Afternoon
Evening

Please indicate your availability for Sunday 29th January 2023: (note games may not be scheduled at all these times, we may also not be able to cater for availability requests and you may be scheduled for other games)*

	Sunday 29/01/2023 Yes available
Morning
Afternoon
Evening

Do you have a Refbook account?*

YesNo
We are using Refbook as our scheduling and payment system for the Senior Country Championships. Please ensure that your bank details are up-to-date in Refbook to allow for prompt payment post tournament.

If you are not on Refbook, please join here: https://live.refbook.com.au/auth/register

You must then email referees@basketballsa.com.au so you can be added to the BSA organisation.
Any information that may assist with scheduling your appointments?
Do you play or follow a team? If so, which Team and Division?
Please indicate your Referee Level:*

Level 0Level 1CLevel 1BLevel 1ALevel 2
DCSI / Working With Children's Check - please provide the following information. Please note if you are under the age of 14, you are not required to fill in this section.*
Signature

Clear
Should be Empty:

SA Senior Country Championships Referee Form