2019 ICC Umpire Expression of Interest and Availability Form

This form is to be used for any officials that wish to express interest in being appointed as an Umpire or Technical Official in the 2024/25 Indoor Club Championsips held at the State Netball Hockey Centre, Parkville & Monash University, Clayton:

Approximate match times:

Friday - 6:00pm - 10:00pm
Saturday - 8:00am - 8:00pm
Sunday - 8:00am - 8:00pm

All Events will take place across both the State Netball Hockey Centre, Parkville & Monash University.

We are seeking expressions of interest for the following roles:

ICC Umpire - $30 per match
JIC Umpire - $20 per match
Technical Official - $20 per match

EOI’s close 2 weeks prior to each events start date (i.e. Open Div 1 - Sunday 19 Jan)

There is a separate form to express interest in the roles of Tournament Directors & Umpire Managers, which can be found here.

Should you have any queries, please contact Charlie Perry (cperry@hockeyvictoria.org.au).

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Club/Association

You will require a valid WWCC or exemption to fulfil any of these roles.

Please check you have added Hockey Victoria as an organisation you work with here: http://www.workingwithchildren.vic.gov.au/home/cardholders/update+your+details/

Hockey Victoria Inc.

Postal Address: P.O. Box 32 Parkville VIC 3052

Phone: (03) 9448 2100

WWCC Declaration*

I acknowledge I have updated my WWCC online to list Hockey Victoria as an organisation I work with or I am exempt from the WWCC (e.g. U18)

WWCC number or list exemption type (e.g. U18)*

WWCC Expiry

Which roles are you interested in?*

UmpireTechnical Official

Please select your current Indoor umpire accreditation:

Please detail your Indoor umpiring experience:

Please select your current Indoor Technical Official accreditation:

Please detail your Indoor Technical Official experience:

Fixtures of each ICC will be released closer to each event.

Your availability can be updated with the relevant UM once the fixture is released.

ICC UMPIRES: Please enter the approx times you are available to umpire (8am - 8pm), for the age groups that you wish to be considered for:

	Fri Start Time	Fri Finish Time	Sat Start Time	Sat Finish Time	Sun Start Time	Sun Finish Time
Open Div 1
Open Div 2
U18
U16
U14
U12
Masters

JIC UMPIRES: Please enter the approx times you are available to umpire (8am - 8pm), for the age groups that you wish to be considered for:

	Sat Start Time	Sat Finish Time	Sun Start Time	Sun Finish Time
U12 JIC
U14 JIC
U16 JIC

TECHNICAL OFFICIALS: Please enter the approx times you are available to act as a Technical Official (8am - 8pm), for the age groups that you wish to be considered for:

	Fri Start Time	Fri Finish Time	Sat Start Time	Sat Finish Time	Sun Start Time	Sun Finish Time
Open Div 1
Open Div 2
U18
U16
U14
U12
Masters

Will you be performing any other roles (playing, coaching) during the ICC? Do you have any family members playing that you would like to watch?

Do you have any medical conditions that we should be aware of? Is there anything we can do to assist you at the event?

Any other comments?

2025 ICC & JIC - Umpire & Technical Official Availability Form

Personal Details

Officials Role

Experience & Accreditation

Availability