Kentucky PIF
Your Name *
Address *
City *
State *
Zip Code *
Home phone *
Work phone *
E-mail *
All ratings held
USAG # *
Safety Certified Expiration Date *
NAWGJ # *
Event Preference 1
Event Preference 2
Event Preference 3
Event Preference 4
Top two highest compulsory meets judged
Top two highest optional meets judged
Top two highest symposium clinics attended
2010 Training Camps worked
  Super Camp Spectator  
  Super Camp Assigned Clinician  
  Hot Shot Camp Spectator  
  Hot Shot Camp Assigned Clinician  
  High Tech Camp Spectator  
  High Tech Camp Assigned Clincian  
  Forward Progress Camp Spectator  
  Forward Progress Camp Assigned Clinician 
2011 Training Camps worked
  Super Camp Spectator  
  Super Camp Assigned Clinician  
  Hot Shot Camp Spectator  
  Hot Shot Camp Assigned Clinician  
  High Tech Camp Spectator  
  High Tech Camp Assigned Clincian  
  Forward Progress Camp Spectator  
  Forward Progress Camp Assigned Clinician 
State meets available to judge
  Level 3-4 State Championship: March 17 - 18, 2012 
  Level 5 - 10 State Championship & Prep Opt. Championship: March 24 - 25, 2012 
Regional meets available to judge
  Level 8 Regionals: April 27 - 29, 2012  
  Level 9-10 Regionals: April 13 - 15, 2012 
National meets available to judge
  Level 9 Eastern Nationals: May 3 - 6, 2012  
  Level 10 J.O. Nationals: May 10 - 13, 2012 
Affiliation with any meet host *
 No 
 Yes 
If yes, pleas explain how.

Powered byEMF HTML Form Builder
Report Abuse