Referee Test
USA WEIGHTLIFTING
APPLICATION TO TEST FOR REFEREE
Test for (check one): USAW Local Referee____ USAW National Referee____ IWF Cat II Referee____ IWF Cat I Referee____
Current Referee Rating (check one): USAW Local Referee____ USAW National Referee____ IWF Cat II Referee ____
Date of Last Test: __________ for (check one) USAW Local Referee____ USAW National Referee____ IWF Cat II Referee____
Event To Be Tested At: __________________________________________________________________________________
Location of Event: __________________________________________________ Date of Event: ___________________________
Your Name: _______________________________________________________________________________________________
Address: __________________________________________________________________________________________________
City: _____________________________________________________ State: ______________ Zip: ______________________
Phone: H:________________________ W: _______________________________ Cell: _________________________________
Fax: ___________________________________________ E-Mail Address:___________________________________________
USAW Member Number: ______________________ USAW Member Expiration Date: ________________________________
Referee Activity Last Two Years:
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Applicant Signature: _____________________________________________________ Date: _________________________
Send to Referee Testing Coordinator:
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Name: |
Roger W Sadecki |
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Address: |
667 County Road C |
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Fax: |
(651) 490-5903 |
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Email: |
sadecki667@aol.com |
