NLL ELITE SHOWCASE CAMP
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Cell Phone
-
Area Code
Phone Number
Place of Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Height
Weight
Gender
Male
Female
Prefer not to answer
Year you began to officiate box and/or field lacrosse:
Highest level of lacrosse you officiated last season:
Your assignor's/supervisor's name, e-mail, phone number:
Reference 1 Name
First Name
Last Name
Reference 1 Relationship
Reference 1 E-mail
example@example.com
Reference 1 Phone Number
-
Area Code
Phone Number
Reference 2 Name
First Name
Last Name
Reference 2 Relationship
Reference 2 E-mail
example@example.com
Reference 2 Phone Number
-
Area Code
Phone Number
Payment ($200.00 CAD) must be made prior to being considered for the Camp using the below link. Payment includes partial meal plan and gift package. Full payment will be refunded if candidate is not selected for the camp. If candidate is selected and chooses not to participate, a $50.00 CAD administrative fee will be withheld.
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=H6L2CH94D687C
I agree to hold harmless Don Koharski, Stripes on Ice LLC, National Lacrosse League Inc., the NLL Officiating Development & Recruitment Camp, and its instructors and assistants from all liability; howsoever caused, relating to my participation at this camp. I authorize the director of this camp to act for me according to their best judgment in an emergency requiring medical attention. It is my understanding that I am required to have medical insurance while participating at this camp.
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