USA PickleballCertified Referee ApplicationPlease complete the USA Pickleball certified referee application form below. X/TwitterThis field is for validation purposes and should be left unchanged.Member Name(Required) First Last Email(Required) Contact Phone(Required)USAP Member ID(Required)Member ID can be found hereAddress(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Polo Shirt Style(Required) Men's Women'sPolo Shirt Size(Required)SmallMediumLargeXL2-XL3-XLDate you perform your Advanced Training Session (ATS)?*(Required) MM slash DD slash YYYY Who conducted your ATS?*(Required)Have you obtained concurrence from your Certified Referee Coordinator (CRC) that you are ready to be evaluated?(Required) Yes NoPlease explain why?(Required)Trainer's Name(Required)Trainer's Phone(Required)Trainer's Email(Required) Date Trained(Required) MM slash DD slash YYYY Location Trained(Required) City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Most Recent Referee Test Score %(Required)Date Referee Test Was Completed(Required) MM slash DD slash YYYY Most Recent Line Judge Test Score %(Required)Date Line Judge Test Was Completed(Required) MM slash DD slash YYYY Most Recent Officiating Procedures Test Score %(Required)Date Officiating Procedures Test Was Completed(Required) MM slash DD slash YYYY Number of matches refereed since training(Required)Enter 0 if NoneNumber of sanctioned matches refereed since training(Required)Enter 0 if NoneList Sanctioned Event Name(Required)Attach a copy of your Visual Acuity Form(Required)Max. file size: 3 MB.Must be dated within the past 12 monthsAcceptance of Terms(Required) I accept I have read and acknowledged that I meet the stated prerequisites and agree to the terms of the referee certification program as outlined on the previous page. If you agree, check the box.Signature(Required)By signing my name I affirm that the information provided above is true and correct.Before you hit the Submit button, please review your form and make sure you have completed all the questions. If all have been answered, hit the Submit button below. You should immediately see a 'Thank You' message saying your application was sent. If you do not see this message, please review your application and look for questions you may have missed. Provide answers to all questions (even if "NA") and then hit Submit. Until you see the 'Thank You' message, USA Pickleball will not receive your application.
