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REGISTRATION FORM
Fill in the following fields and submit for registration with DVSRA:
*
Indicates required field
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Address
*
Email
*
City
*
State
*
Cell Phone
*
ZIP Code
*
Emergency Contact Name
*
Emergency Contact Phone
*
SafeSport Training Date
*
https://safesport.org/authentication/register?token=ee57337f-31f9-421d-b095-82fc8c8c4c41 Enter Access Code: YC3E-6P5G-YYIL-CS2M U.S Soccer is your Organization. Enter Access Code: YC3E-6P5G-YYIL-CS2M
Certification Level
*
USSF ID#
*
Number of Years as Referee
*
Interested in High School Refereeing?
*
YES
NO
If 18 years or more, have you been fingerprinted for refereeing?
*
YES
NO
You must be in good standing with the DVSRA to be accepted. Membership approval is at the discretion of the DVSRA board.
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Home
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About Us
Become a Referee
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Contact