Request a Clinic

Are you a Club, Association, or an Instructor? Do you wish to host a Clinic in your area for Referee Training?

Fill out the form below and submit your request. It will be sent to the State Director of Instruction (SDI)R. C. (Chip) Walaska, at All areas of the form must be filled out unless noted specifically otherwise.

NOTE THE FOLLOWING: After you have submitted the Form, please call the SDI at 319-651-7404 to confirm receipt of your clinic request, discuss the particulars of the class, and to get any questions answered.

We will make every attempt to honor requests from Organizations, Clubs, Referee Associations, Assignors or Registered Instructors as the Schedule permits. We suggest that you check the current Event Calendar to see if there are any major conflicts with your date(s), e.g., with the annual Terry Vaughn Referee Academy, prior to submitting your request.

Most Entry-Level Clinics are a day-and-a-half long, starting Friday evening and then continuing all day Saturday. But, other arrangements can be made. The Clinic Sponsor will need to provide a Classroom with tables and chairs. The Classroom may also need a blackboard / white board or flipchart easel and paper. The Instructor may require a Projector and Screen for slide projection. The Clinic Sponsor is responsible for recruiting students and collecting all funds, and a Representative must be on site during the class.

NOTE: The Clinic Sponsor must guarantee at least 10 paid participants. If not, the Clinic Sponsor must make up the cost difference.

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: