2021 AAU Region 17 National Qualifier

2021 AAU Region 17 National Qualifier

Officials Application

June 30-July 3rd, 2021

Challenger Stadium
1955 W Nasa Blvd
Webster, Texas 77598

Meet Director
Jerrome Forest
jerromef@aol.com
(281) 386-5349

First Name:*

Last Name:*

Gender:*

Male

Female

E-mail:*

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Subscribe?*

Yes

No

Address:*

Street Address City State / Province / Region Postal / Zip Code

Type:*

Home

Work

Cell

Primary Phone:

Area Code

-

Phone Number

Name of Emergency Contact:*

First

Last

Phone of Emergency Contact:*

Area Code

-

Phone Number

List any allergies, medications, or medications we should be aware of:

Certification Number/ID:

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:*

Wed, June 30

Thurs, July 1

Fri, July 2

Sat, July 3

How will you be traveling?: *

Air

Car

Other (Explain below)

Other travel arrangements:

Roommate Preference: (Lodging will be by request only and it must be communicated in advance.)*

I will not need housing accomodations

Please assign me a roommate

I would like to room with the individual(s) listed below:

Roommate(s) Requested:

Noteworthy Accomplishments:

Please inform us of any special dietary requests.

Request:*

I have no special dietary requests

I am a vegetarian

Other (explain below)

Dietary Explanation

Do you have an athlete or team competing in this event? :*

Yes

No

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.