Complete the following form and press Submit at the bottom to pre-register for the Academy
All areas of this form MUST be completed!

First Name:

Middle Initial:*optional - if none, leave blank

Last Name:

Address:

City:

State:

Zip Code: (5-digits only)

Home Phone:

Work Phone: *optional - if none, leave blank

Email Address:

Order an Iowa Referee Academy T-Shirt (optional) - $12.00**
Select Size (leave on No T-Shirt if you do not wish to order a t-shirt):
No T-Shirt S M L XL XXL

Make a Free Will Offering to the Iowa Referee Academy? (optional) **
Select Amount (leave on No Offering if you do not wish to make a offering):
No Offering $10.00 $20.00 $30.00 $40.00 $50.00

**Payment for t-shirts and offerings can be made in one of two ways:
1) When you click the Pre-Register button below, a screen will appear where you will be allowed to pay online via credit/debit card or online checking account via the same system that is used for online registration.
2) Bring a personal check to the Academy.

All proceeds from shirt sales and free will offerings will go to benefit the Iowa Referee Academy.