Registration Name * First Name Last Name Gender Male Female Other Date of Birth * MM DD YYYY Current CSA Classification * District Regional Provincial National FIFA Email * Phone * (###) ### #### City of Residence * Dietary Restrictions I require accommodation in Edmonton * We have procured accommodations for out of town officials at a rate of $59.50 per night based on double occupancy. Cost will be the responsibility of the participant. Yes No Unsure, but keep me updated Shirt Size-NB:Macron Sizing * For sizing please visit: https://www.macron.com/en/size-guide Men's Small Men's Medium Men's Large Men's X-Large Men's 2XL Men's 3XL Women's Small Women's Medium Women's Large Women's XL Women's 2XL Women's 3XL Number of Years Refereeing * 1 Year 2 Years 3-5 Years 5-10 Years 10+ Years Emergency Contact First Name Last Name Emergency Contact Phone Number (###) ### #### If Minor, Name of Parent/Guradian First Name Last Name If Minor, Phone Number of Parent/Guardian (###) ### #### Image Use Agreement * As a participant of the 2024 Advanced Referee Camp, I hereby grant authorization to the Alberta Soccer Association (ASA) and the Edmonton CARD and its representatives to photograph and video me, and otherwise capture my image, and to make recordings of my voice. I further grant to ASA and Edmonton CARD and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute these images and recordings in any media now known or later developed for promoting, publicizing or explaining Advanced Referee Camp and its activities and for administrative, educational or research purposes. Photographs, video images and voice recordings are the property of the ASA and Edmonton CARD. I agree with the Image Use Agreement Other Notes Thank you!
