Regional Referee Application

All policies and procedures for referee testing can be found in the Referee Testing Requirements and Procedures Manual (found on the Technical Committee portion of the national website). It is your responsibility to be familar with these policies, procedures, and requirements.
If you have not heard back about this application within 7 days of submitting it, or if you have any questions, please contact the chair of the Technical Committee at the following email address: tc@usapowerlifting.com

Name (as it appears on your USA Powerlifting membership card)*

First NameLast Name

Email address (this email will be used to contact you regarding this application)*

Confirmation EmailConfirm email address

State (as it appears on your USA Powerlifting membership card)*

USA Powerlifting membership number (must be a current member)*

Example: 1111111

Date that current USA Powerlifting membership expires*

Date

State chair's name*

If you live in a state without a current state chair, please enter "vacant" above

STATE CHAIR LIST AND CONTACT INFORMATION. A list of current state chairs and their email addresses can be found on the State Chairs portion of the national website.

Has your state chair given approval for you to be promoted to the regional referee rank? Applicants who live in a state without a current state chair must be approved by the chair of Technical Committee. Note: Your state chair will be contacted to confirm they have given approval.*

YesNoState chair vacant - approved by Technical Committee chair

Date (month and year) that you attained the rank of state referee*

Have you completed SafeSport training and is your SafeSport training current?*

YesNo

Has your background check been completed?*

YesNo

Have you gone through drug testing training?*

YesNo

Are you experienced and proficient with all of the following: equipment check (both raw and equipped), weigh-in, score table, and drug testing.*

YesNo

How many total meets have you refereed in the most recent 4-year period?*

Example: 12

LIST OF REQUIRED MEETS. In order to be eligible to be promoted to the regional referee rank, candidates must have been a platform referee (side of chief) for an entire session at six (6) different full power events. For more detailed information about the requirements, please see page 10 of the Referee Testing Requirements and Procedures Manual. Please list those six (6) events and your referee position for each below. If you cannot remember the details of the events you worked, you likely can find them in the Results portion of the national website.

Event #1: Year*

Example: 2025

Event #1: Event name*

Example: Texas State Championship

Event #1: Event state*

Event #1: Served in the following position for a full session*

Side refereeChief referee

Event #2: Year*

Example: 2025

Event #2: Event name*

Example: Texas State Championship

Event #2: Event state*

Event #2: Served in the following position for a full session*

Side refereeChief referee

Event #3: Year*

Example: 2025

Event #3: Event name*

Example: Texas State Championship

Event #3: Event state*

Event #3: Served in the following position for a full session*

Side refereeChief referee

Event #4: Year*

Example: 2025

Event #4: Event name*

Example: Texas State Championship

Event #4: Event state*

Event #4: Served in the following position for a full session*

Side refereeChief referee

Event #5: Year*

Example: 2025

Event #5: Event name*

Example: Texas State Championship

Event #5: Event state*

Event #5: Served in the following position for a full session*

Side refereeChief referee

Event #6: Year*

Example: 2025

Event #6: Event name*

Example: Texas State Championship

Event #6: Event state*

Event #6: Served in the following position for a full session*

Side refereeChief referee

By signing below, I agree to the following terms:

I affirm that I meet all of the requirements to become a regional referee as listed on page 10 of the Referee Testing Requirements and Procedures Manual (found on the Technical Committee portion of the national website).
I affirm that all of the information I provided in this form is accurate and truthful.
I understand that by submitting this application, it is not guaranteed to be approved. If it is not approved, I understand that I will be told the reason(s) why it was not approved.
I understand that the regional referee rank is a temporary
one lasting up to one (1) year in which time it is expected that I will complete the process to become a national referee. If, after one year, I have not successfully become a national referee, I understand that I will automatically revert to my previous state referee rank.
I understand that, as a regional referee, I am eligible to adjudicate national record attempts at national championship events only. I understand that I am not eligible to adjudicate national record attempts at any events that are not national championship events.

Signature*

Regional Referee Application

Electronic Signature