Largo United Halloween Tournament
Presented by Largo United Soccer Club
Friday, October 16th thru Sunday, October 18th
Referee Availability Form
Eddie Pena-USSF Referee Assignor 07 Return this Form ASAP to
PO Box 270394 Tampa, FL 33688 Eddie Pena to be considered
Phone: 813-961-7701 Fax#: 813-961-7701 for the tournament assignments.
Email: Edsoccerref@aol.com We look forward to having you participate!
Website: http://EdPena.net To submit online, log on to edpena.net
Last Name ____________________________, 1st Name _________________________________
Address ________________________________ City ____________ State ________Zip _______
Date of Birth ___________ Gender (X) Male ____ or Female ____ FYSA Certified: Yes __ NO __
2008 USSF Registered (X): yes __ or No __ Current Referee Grade: ___ Date Attained: ________
Home Phone: ________________ Work Phone ________________ Cell Phone ________________
Email ______________________ Fax # __________________If affiliated with a club, provide info:
Club _______________________ Team ___________________ Division ______ Age Group _____
Days and Times you are available: Sites:
Friday ----- 10/16/09 6PM to 9PM Yes ___ or No ___ Largo Soccer Complex
Whitesell Complex
Saturday--- 10/17/09 8AM to 12PM Yes ___ or No ___ Osceola Soccer Complex
12PM to 4PM Yes ___ or No ___
4PM to 8PM Yes ___ or No ___
Sunday ---- 10/17/09 8AM to 12PM Yes ___ or No ___ Gender Preference: Girls __ Boys __
12 PM to 4PM Yes ___ or No ___ Age Preference: ________________
Do you need hotel accommodations? Yes __ or No __ If yes, which nights? ___________________
Name of roommate preference __________________ Special requests ________________________
Snacks & Drinks will be provided at each venue.
Assignments will be posted at http://gameofficials.net with additional info at http://edpena.net
Game fees
U9-10: Ref $23
U11-U12: Ref $25, AR’s $17
U13-U14: Ref $31, AR’s $19
U15-U18: Ref $43, AR’s $23
Submission of form does not guarantee selection to officiate in this event.