Official Application CSI Senior Championship

July 14-17, 2016 @ Wesleyan University

Contact Information
First Name:*
Last Name:*
Email:*
Preferred Phone Number:
Select the gender of your athlete(s) competing in the meet:* Female Male Both None

Club and Certification
Indicate Club Affiliation:
CT Club Code:*
Your LSC highest level of certification:* Administrative Official Stroke & Turn Chief Judge Starter Deck Referee Administrative Referee Meet Referee
Do you have previous championship meet experience?* Yes No
Do you still need one (1) Championship Meet (Regionals, Age Group or Seniors) work session for CT Officials re-certification?* Yes No Not Sure
If applicable, please list your USA Swimming national certifications:
   

Select sessions you are available to work.
Morning Preliminary Sessions:
Thursday
Friday
Saturday
Sunday
Evening Final Sessions:
Thursday
Friday
Saturday
Sunday

Comments/Questions:
   
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