Request a Clinic

Are you a club, association, or instructor?  Wish to host a clinic in your area for referee training? 


Fill out the form below and submit your request to the State Director of Instruction.  All areas of the form must be filled out unless noted specifically otherwise. 


Please note that we will make all attempts to honor requests from organizations clubs, associations, or registered instructors so long as the schedule permits.  We suggest that you check the current Calendar to see if there are any major conflicts with your date(s) prior to submitting your request.   THE WEEKEND OF AUG 13, 2010 IS NO LONGER OPEN


The clinic sponsor will need to provide a classroom type setting with table and chairs.  The classroom will also need a blackboard or white board.  A television and a VCR is needed (the instructor may need a LCD projector) as well as a screen for projection.  The sponsor is responsible for collecting all funds.  A representative must be on site during the class.  The sponsor needs to recruit the students.

Request a Clinic...
Type of Clinic:
    
Your Name:
    
Club or Association Host:
    
Clinic Contact Name:
    
Clinic Contact Phone #:
    
Clinic Contact Email:
    
Clinic Location: (address, city, building #, etc)
    
Clinic Attendance Cap:
(If there is a maximum attendance capacity for this clinic venue, enter it here, otherwise leave it blank to indicate "unlimited" attendance allowance)
    
Clinic Date(s) and Time(s):
(example: Saturday 01/01/2009 8am-5pm, Sunday 01/02/2009 8am-12pm)
    
Estimated # of Students:
    
Instructor: (complete only if you have an instructor already willing and able to lead this clinic, otherwise leave blank and one will be assigned)
    
Other Important Notes: