FORM - Futsal 2022 — CVSRA

Home About New Member Hall of Fame Training Game Procedures

Home About New Member Hall of Fame Training Game Procedures

Jefferson Cup Futsal Registration Form:

Sign up to work Jefferson Cup FutsalRVA Dec 9-11 and Dec 16-18

First Name *

Last Name *

Date of Birth *

MM

DD

YYYY

Street Address *

City *

State *

Zip Code *

Cell Phone # *

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Dates/Times available to work

Check all that Apply

Friday 9th

Saturday 10thAM Only

Saturday 10th PM Only

Saturday 10thAll Day

Sunday 11th AM Only

Sunday 11th PM Only

Sunday 11th All Day

Friday 16th

Saturday 17th AM Only

Saturday 17th PM Only

Saturday 17th All Day

Sunday 18th AM Only

Sunday 18th PM Only

Sunday 18th All Day

team affiliation IF applicable

If you or a relative is playing on a team playing in the tournament please let us know which one.

Email *

Certification *

I Confirm I am currently Futsal Certified for 2021 through US Soccer

Yes

No

There are no hotel rooms available for this tournament. If you are coming from out of town, and only want to work 1 day, that is fine, please let me know.

Thank you!

Soccer Official's Covid-19 Protocol (squarespace.com)

Contact - General

Name *

First Name

Last Name

Email *

Select *

Subject

Message *

Thank you for reaching out to CVSRA. Your message is being reviewed by a CVSRA representative. You can anticipate a response in the next 3 business days.

Thank you,

CVSRA

Central Virginia Soccer Referee Association

(804)-744-4900 info@cvsra.com

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