2012-2013 Officiating Program Registration Form
Please answer all questions that apply to you, most importantly all questions marked with a "*".

1) Name:	First Name: *
	Last Name: *
2) Birth Date (MM/DD/YYYY Format): *
3) Address: *
4) City: *
5) Province: *
6) Postal Code: *
7) E-mail Address (Seperate multiple with a comma): *	No E-mail Address?
8) Home Phone ( (999)-999-9999 Format): *
9) Work Phone ( (999)-999-9999 Format):
10) Cell Phone ( (999)-999-9999 Format):
11) Please select:	Referee Timekeeper Ref & Timekeeper
12) Have you ever officiated or timekept in this district?	New Official/Timekeeper	Returning Official/Timekeeper
13) HCOP Number: (referees only)				No HCOP Num? Please Leave Blank.
14) HCOP level 2012-2013: (referees only)	I      II      III      IV      V      VI
While game assignments will still be made by telephone, newsletters, as well as notices and reminders for meetings, clinics, tournaments, and referee social events will be sent out primarily by e-mail. This is not a junk mail or SPAM list. Mass-emails once or twice per month simplify things for the assignors and officiating executive, allowing many people to be contacted in a quick and easy manner.
15) I would prefer my correspondance:	by e-mail/Internet	by mail/telephone
For timekeepers only:
16) How many seasons have you been a timekeeper?
17) What is the highest level of hockey you have regularly worked as a timekeeper?
For referees only:
18) How many seasons have you been a referee/linesman?
19) What is the highest level of hockey you have regularly worked as a referee in the three-official system or in the two-official system?
20) What is the highest level of hockey you have regularly worked as a linesman in the three-official system?
21) Please indicate approximately how many games you are available to work or would like to work per week.
22) Generally, are you available for games on short notice? (i.e. Would you like to be called on short notice?)				Yes No
23) Please estimate how many times you were supervised in 2011-2012.
For level III (and higher) referees only:
24) Did you supervise or attend a supervisors clinic in 2011-2012?				Yes No
25) Would you like to supervise in 2012-2013?				Yes No
26) Did you 'buddy' in 2011-2012?				Yes No
27) Would you like to 'buddy' in 2012-2013?				Yes No
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