International Referee Application

International Referee Application
Full Legal Name*

First NameMiddle NameLast Name
Age*
Sex*
Country/Nation*
Fluency in English language?*
Email*

Confirmation Emailexample@example.com
For which level of referee are you applying?*

LocalNationalCategory 2 (Junior International)Category 1 ( Senior International)
Are you now or have you been a certified referee in a powerlifting organization?*
If you are or have been a certified referee in a powerlifting organization, please list the referee rank/level you hold/held, the organization(s) you are/were certified by, and the years you were active as a certified referee for each
Enter organization name
Referee rank?

Local (eligible to referee at local meets only)National (eligible to referee at local and national meets)International (eligible to referee at local, national, and international meets)
Enter years active?
Have you completed SafeSport?*
USA Powerlifting Rulebook
How well do you know the rules contained in the USA Powerlifting Rulebook?*
What powerlifting organizations have you been a member of (please list the full name of all powerlifting organizations up to 5) (if none, type "None" in the first box)?*
How many years have you been involved with the sport of powerlifting?*
How many meets/events have you participated in as a LIFTER?*
How many meets/events have you participated in as a COACH?*
How many meets/events have you participated in as a SIDE REFEREE?*
How many meets/events have you participated in as a CHIEF/CENTER REFEREE?*
By signing below, I affirm that all of the information I provided in this form is accurate and truthful. Further, I understand that any falsified information on this form may result in a rejection of my application to become certified in the USA Powerlifting referee program or a temporary or permanent suspension if I am already in the program.
Signature*

Clear
Should be Empty:

International Referee Application

USA Powerlifting Rulebook