Asics®/Tampa Bay’s BIG SOUTH National Qualifier
Referee’s Reservation Card

 Fill in the Email Form below and submit the information using the button at the bottom of the page. The information will then be sent to us automatically. A Copy of the completed form will automatically be displayed. You can then print a copy of the form for your own records. If you do not receive a FINAL confirmation response from us within 72 business hours,
contact Mike Carter at cartersvb@verizon.net .

First Name:

Last Name:

Address:

City

State

Zip

Daytime Phone:

Evening Phone:

Email Address (required):

Certification Level

If Regional or Provisional, what USAV Region are you in?

Polo-style men’s shirt size

Do you need a MARTA Pass?

MAKE SURE TO MARK THIS BOX CORRECTLY -- if you request a pass, you are agreeing to work all 3 days of the event.

Arrival Information (if known at this time):

Time:

Airline:

Flight #:

Please note that all officials have to arrive in time to attend the 9:00 PM meeting on Thursday March 24, 2005.

Do you have any schedule restrictions for working the event?

PLEASE NOTE: After you click on the submit button, you will see a confirmation page.