2023 Russell E. Blunt East Coast Invitational Official App

2023 Russell E. Blunt East Coast Invitational

Official Application

July 21-23, 2023

Durham County Memorial Stadium
750 Stadium Drive
Durham, North Carolina 27704

Questions?
Contact
Frank Davis
919-451-9792
fdavis@durhamstriders.com

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

Primary Phone:*

Area Code

-

Phone Number

Type:*

Home

Work

Cell

Secondary Phone:

Area Code

-

Phone Number

Type :

Home

Work

Cell

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. *

Friday, July 21

Saturday, July 22

Sunday, July 23

How will you be traveling?: *

Air

Car

Other (Explain below)

Other travel arrangements:

Roommate Preference:*

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.