1st – 15th August 2015
APPLICATION FORMFOR OFFICIALS FOR
LIFESAVING 2015
Name:
Given (First or called name):Family (Last or surname):
Date of Birth:Age:
National Federation and Club:
Federation eg SLSGB, SLSA Wales, RLSS, ASA / SLSA WalesClub eg LLantwit Major
E-Mail (This address will be used in all future correspondence. If you do not have e-mail address – any other e-mail address that can be used for correspondence):
Qualification: Date qualified as an Official, the Federation/Authority who issued the qualification, and any further qualifications (levels obtained):
Date / Qualification / Federation/Authority / LevelAPPLICATION FOR POOL CHAMPIONSHIPS
Pool and SERC Championships you would like to officiate in.
Championships / Dates / “X” Championships you would like to officiate inNational Teams Simulated Emergency Response / 2 August
National Teams Pool / 34August
InterClub Simulated Emergency Response / 9 August
InterClub Pool / 9, 10 & 11 August
Positions you would like to officiate in, please list in priority order (1, 2, 3, 4, 5 – please only list 5 options) which position you wish to be considered for in each event, 1 being the most preferred position. Please note you are not required to complete each and every block – only 5 or less.
Position
/ Rank (5 only)Jury of Appeal
Commentator
Starter
Competitors Liaison
Presentations
Lane Judge
Turn Judge
Finish Judge
Place Judge
Marshall/ Security
Chief Timekeeper
Time Keeper
Equipment/ Gear Manager
Other: Specify
Please list your particular skill and experience that you may have in the positions you have applied for in the pool (i.e. Lane Judge, Timekeeper, etc.). Please statethe date, what Championships and position held in the last 4 years.
Date / Championships / PositionAPPLICATION FOR OCEAN & BEACHCHAMPIONSHIPS
Ocean & Beach, Championships you would like to officiate in.
Championships / Dates / “X” Championships you would like to officiate inNational Teams Ocean & Beach / 6 & 7 August
InterClub Ocean & Beach / 13, 14 & 15 August
Positions you would like to officiate in, please list in priority order (1, 2, 3, 4, 5 – please only list 5 options) which position you wish to be considered for in each event, 1 being the most preferred position. Please note you are not required to complete each and every block – only 5 or less.
Position
/ Rank (5 only)Jury of Appeal
Commentator
Presentations
Area Referee
Deputy Area Referee
Chief Judge (overall place judge)
Judge
Judge in Boat
Starter
Check Starter
Marshall
Recorder
Scrutineer
Other: Specify
Please list your particular skill and experience that you may have in the positions you have applied for in the pool (i.e. Starter, Marshall, Recorder, etc.). Please state the date, what Championships, Position and Section held in the last 4 years.
Date / Event / Position / SectionPlease complete the following declaration:
Name (enter in Block Capitals):
I hereby would like to be considered for appointment toan Official at Lifesaving 2015, the Lifesaving EuropeanChampionships. I am currently a member of RLSS/SLSA WALES (Federation)
I am in good standing with the above mentioned Federation.
I understand that I will be responsible for all travelling and accommodation expenses for Lifesaving 2015and that no claim for such expenses will be made to the Lifesaving 2015 Organising Committee, Surf Lifesaving Great Britain, Surf Lifesaving Wales or ILSE.
I further undertake to make myself available for the full duration of the Championship to which I am appointed as an Official including the pre and or after Championship briefings as required by the Chief Referee.
Signed:
Date:
Application on the form set out above, should be sent to Andrea Pennell - Event Management Committee - to arrive not later than Sunday 15 March, 2015 by:
E-mail:
1