2017 USATF 29th Annual USA-Canada Junior Race Walk Match Officials App

29th Annual USA-Canada
Junior Race Walk Match

Officials Application

Friday-Sunday, August 18-20, 2017

Heritage Riverways Trail System
Rome Braves Stadium Trailhead
755 Braves Boulevard (lower/east parking lot)
Rome, Georgia

Questions?  Contact
Jean Williams
First Name:*
Last Name:*

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Primary Phone:*
Secondary Phone:
Type :
Name of Emergency Contact:*
Phone of Emergency Contact:*
List any allergies, medications, or medications we should be aware of:
Certification Level:*
Certification Number/ID:
T-shirt size:*

Please select four (4) areas you would like to work in order of preference (DO NOT select same area for all 4 choices)

Preference 1:*
Preference 2:*
Preference 3:*
Preference 4:*
Please select all the days you will be available:*
How will you be traveling?: *
Other travel arrangements:
Roommate Preference:*
Roommate(s) Requested:
Noteworthy Accomplishments:

Please inform us of any special dietary requests.

Dietary Explanation
Are you competing and/or do you have an athlete or team competing in this event?"*
Please let us know if you have any other special requests or information to share with the officials coordinator:
Please upload a headshot and picture of your officials certification card. File formats accepted (jpg, jpeg, png, gif, doc, docx, xls, xlsx). Max upload 2MB.

Please ensure you have provided an accurate email before submitting your application. This will be the primary form of communication for informing you of your application status.