Request Scorer / R2 Clinic

Please complete the information below to request a scorer and/or referee clinic at your location.

If yes/no field is left blank, it will be assumed the answer is no.
This form is to be filled out by club directors only; the name of the adult on-site supervisor for the clinics should be listed.
The earliest a clinic can be held for the 2017-2018 season is November 1rst.

Please complete this form to request a clinic. Clinics cannot be held in a private dwelling.
Requesting Club:*
Club Director Name*
First Last
Phone*
Email*
Complete Facility Address & Room#*
Type of Clinic*
- R2 Clinic
- Scorer Clinic
- Both
Day/Date/Time of Score Clinic - 1st Choice:
Date*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Day/Date/Time of Score Clinic - 2nd Choice:
Date*
MM slash DD slash YYYY
Time*

: Hours

Minutes

AM/PM
Clinic Open to Non-club Members?*
- Yes
- No
Projector and Screen Provided By You?*
- Yes
- No
Laptop/Computer Provided By You?*
- Yes
- No
Captcha
Phone
This field is for validation purposes and should be left unchanged.

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