REFEREE REGISTRATION

Title *

This field can't be Empty

First Name *

This field can't be Empty

Last Name *

This field can't be Empty

Date of Birth *

This field can't be Empty

Gender *

Male Female This field can't be Empty

Street/Town/City/County *

This field can't be Empty

Telephone *

This field can't be Empty

Email *

This field can't be Empty

Please state the league you currently officiate in *

This field can't be Empty

Please state the referee grade you currently hold *

This field can't be Empty

Have you attended an FAI Safeguarding 1 course? *

Yes No This field can't be Empty

Date of attendance and venue if you attended FAI Safeguarding 1 course: *

This field can't be Empty

Have you valid FAI Garda Vetting clearance? *

Yes No This field can't be Empty

Date of Expiry: *

This field can't be Empty

Are you a member of a club affiliated to the FAI? *

Yes No This field can't be Empty

If Yes, please state which club you are a member of?

This field can't be Empty

Your Role in the club you are a member of?

Player Coach Admin Other This field can't be Empty

Do you hold a position within a league affiliated to the FAI *

Yes No This field can't be Empty

Are you a member of the Irish Soccer Referees Society *

Yes No This field can't be Empty

DECLARATION *

I hereby apply to be registered as an FAI Referee until July 31st 2021. I undertake to abide by the FAI’s Rules, Referee Regulations and Code of Ethics and understand that failure to comply could result in my registration being cancelled by the Association. I declare that I do not have any reason, medical or otherwise, which would prevent me from undertaking the physical test or fulfilling my duties as a referee. This field can't be Empty

Parent/Guardian Last Name

This field can't be Empty

Parent/Guardian First Name

This field can't be Empty

Please tick the box if you wish to receive this information

The FAI may forward information of interest to you in relation to FAI events, courses, ticketing arrangements or other FAI related activities. This field can't be Empty