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When applying for an England Netball Course please complete ALL information on this booking form

Course Details
Name of Course: / Officiating Masterclass Genting Arena
Course Date / 29th November 2017 / Course Venue / Genting Arena, Birmingham
Learner Details
Learner Full Name
Contact Email
Telephone / Mobile
Learner Address
City/Town / Postcode
England Netball Affiliated Region / England Netball Affiliated County
England Netball Affiliation Number
Emergency Contact Details
Emergency Contact Name
Emergency Contact Number
Medical Information (Please state all medical conditions e.g. epilepsy, asthma, diabetes, allergies etc.
Please list below any Officiating and Netball Experience you have
Please note: For some practical workshops participants may need to be actively involved in netball skills and drills. If you are not able to actively take part, please inform the course organiser at the point of booking.
Cost &
Payment Details /

Cost: £60 which will include a Gold Band Match Ticket (£36)

Name of Bank: Barclays Bank

Account Name: All England Netball Association Ltd
Account No: 60067857
Sort Code: 20-92-54
Cheques to: The Officiating Department, England Netball SportPark, Loughborough
University, 3 Oakwood Drive, Loughborough, LE11 3TU
Ref Number: 230/1495 (please ensure you use this so we can track your payment)
Cancellation Policy / Requests to cancel a booking should be directed to
and will be considered on an individual basis.

Course attendees are invited to rank order their preferred content and the Masterclass will be built on the needs of the learners attending.

Competencies / Rank Order
(1 high)
Position and Timing
Vision
Game Management & Protocols
Contact
Obstruction
Advantage
Minor Infringements
Communication

Monitoring Information

Are you male or female?
Date of Birth
What is your ethnic group?
White / White British / Black or Black British / Black Caribbean 
African 
Other Black 
Mixed / White & Black Caribbean o
White & Black African o
White & Asian o
Other Mixed o / Chinese or Other Ethnic Group / Chinese o
Other Ethnic Group o
Asian or Asian British
/ Indian 
Pakistani 
Bangladeshi 
Other Asian  / Prefer not to say / o
Unknown / o

The Disability Discrimination Act 1995 defines a disabled person as anyone with a ‘physical or mental impairment which has a substantial and long-term adverse effect upon his/her ability to carry out normal day to day activities.’

Do you consider yourself to have a disability?
If Yes, what is the nature of your disability?
Visual o / Learning o / Hearing o / Multiple o
Physical o / Other o / Prefer not to say o

FOR OFFICAL USE ONLY (Course Organiser to complete):

Any further action required:

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Payment received: Yes No

Place confirmed Yes No