Official’s Application
Regional 16
                                               Regional Qualifier Meet

                                                                                                                                                            

Please complete this application and return to: Larry Bryant @ Region16yaa@gmail.com NO LATER THAN: June 01.

Please print
Name  	

Male 	Female

Address  	City  	State  	Zip  	

Email  	Phone  	Shirt Size 	

  Your Shirt Size (S, M, L, XL, etc.):_______

Official Certification level  	

Certification number 	

Availability:
   Thursday,          _____   Friday________   Saturday_________  Sunday_________

Event preference:   Number 3 events in order of preference with 1 being the most preferred.

Long Jump  	

Triple Jump  	

High Jump  	

Pole Vault  	_

Shot  	

Discus  	

Javelin  	

Combined Events  	

Race Walk  	

Clerk  	

Umpire  	

Inspector of Implements  	

Finish Line _ 	

Lap Counter  	_

  No Preference_____  	

List up to 4 events you have officiated in the last two years:
Event 	Date 	    Responsibility
1.  	_________

2.   	_________

3.   	_________

4.   	_________

If you need information or have a question, please contact: Larry Bryant @
 501-730-3299 or email: Region16yaa@gmail.com