REFEREE REGISTRATION FORM

Title *

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Date of Birth *

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Last Name *

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First Name *

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Gender *

Male Female This field can't be Empty

Town/City/County *

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Home Telephone

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Mobile Telephone *

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Email *

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Please state the league you currently officiate in *

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Please state the referee grade you currently hold *

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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:

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Have you valid FAI Garda Vetting clearance? *

Yes No This field can't be Empty

Date of Expiry (If you have a FAI Garda vetting clearance):

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Are you a member of a club or league or society affiliated to the FAI?

Yes No This field can't be Empty

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

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Your Role in club/league/society you are a member of?

Player Coach Admin Other This field can't be Empty

If Other Role (Please specify)

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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

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Parent/Guardian First Name

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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