STSR Referee Development Program
Clinic Application/Registration Form
This form is to be used for registration for a variety of state-sponsored clinics. Please fill out ALL sections of this form,
whether or not they seem to apply to the clinic for which you are registering.
Clinic Number:
Clinic (pick one):
State Referee Upgrade
Associate Instructor
Referee Assessor
Assessor In-Service
State Referee Recertification
Referee Instructor
State Assessor
Instructor In-Service
Name:
Address:
City:
Home Phone:
Advanced Referee
Associate Assessor
Assignor
USSF ID:
e-mail:
State ZIP:
Work Phone:
Game Experience:
Center
Men Div 1 & up
Other Amateur Men
U19
Line
Shirt Size:
(pick one)
S
XL
M
XXL
L
XXXL
Clinic Information
Procedure:
Fill out this form. E-mail or mail the form, and mail the appropriate fee(s), to the person at the bottom of this form.
Once you are accepted in the clinic, you will receive a letter/e-mail that will explain the details about your particular
clinic.
Fees:
All clinics have a $25.00 clinic fee that is due with this registration form plus the applicable USSF registration fee. All
checks or money orders are to be made out to “STSR”. If the fee is not received with this form and other
arrangements are not made, the form will be sent back to you.
Attire:
USSF casual attire is required unless otherwise notified. This means polo shirts and slacks/warm up pants. No jeans,
shorts or t-shirts will be allowed.
What to bring:
Associate Assessor/Assignor clinics: Pen, pencil, writing tablet.
Instructor clinics are indoor clinics. Dress comfortably, yet as you would appear to provide instruction to a referee
group. Any and all reference material will be useful. Supplies, such as pens, pencils, paper, transparencies, visual
aids, are all useful. Be creative. Think ahead!
State Referee/Assessor clinics have both indoor and outdoor sessions and usually have a physical test. Dress
comfortably. Bring running clothes, reference material (Law book, Q&A, etc.). Bring a complete referee uniform to
ALL State Referee clinics.
Costs:
You are responsible for paying all clinic costs. Clinic costs can include room, meals, travel and registration fees. STSR
may reimburse you for some or all of those expenses. The acceptance letter you receive about each clinic will explain
what costs will be reimbursed.
Return form with fee(s) to:
clinform.doc 07/26/06
REFEREE, INSTRUCTOR &
ASSIGNOR COURSES
STSR
5300 N. Braeswood #377
Houston, Texas 77096
dir@stsr.org
ASSESSOR COURSES
Enrique Sanchez SDA
1801 Norwood
Deer Park, TX 77536
E-mail: sda@stsr.org