Application to Officiate

Application to Officiate
Potomac Valley Long Course Senior Championships
University of Maryland
July 13-16, 2006

You may use this form to apply to officiate the Potomac Valley Long Course Senior Championship meet. You may also email your request to the Meet Referee. Any questions or comments about this form can be directed to

Name:     Club:

E-Mail:     Phone No:

Current Certifications and Level (check all that apply):

Referee    Starter    Stroke&Turn   
Hy-Tek     Colorado

Sessions (check all that apply):

I can serve at all sessions Yes No
Thursday Distance Friday Prelims Friday Finals
Saturday Prelims Saturday Finals Sunday Prelims Sunday Finals

Comments (include specific assignment requests here):


It is requested that you apply no later than July 4th. However, late applications and walk-ins are also welcome.

We have applied to have this meet designated as a "qualifying meet" under the new national officials' certification program. Any official interested in being evaluated should contact the Meet Referee for more information and an application to be evaluated. Details of the certification program can be found on the USA swimming website at: