APPLICATION TO OFFICIATE
2017 South Western Age Group Regional (SWAGR)Roseville Aquatic Complex
Roseville, California
March 16-19, 2017
Applicant must be a current member of USA Swimming and an LSC certified official
Name: LSC Code:
Address: Home Phone:
City, State, Zip: Work / Cell Phone:
Email address:
Current Certifications - List Highest Position
LSC/N1:
/Exp Date:
National Level N2:
/Exp Date:
National Level N3:
/Exp Date:
This meet is designated as a National Officials Qualifying Meet. Those officials wishing to be evaluated will need to fill out a separate Request for Evaluation.
Applications for the assigned positions of Chief Judge, Starter, and Deck Referee must be received no later than Monday, March 6, 2017. Notification of assigned positions will hopefully be sent by Friday,
March 10, 2017. All other applications must be received no later than Monday, March 13, 2017.
Requested Assignment:
(Stroke & Turn, Chief Judge, Starter or Deck Referee, as needed)
Please check the sessions you will be available to officiate.
I will serve at all sessions []
I can only serve at the following sessions - Officials’ briefing
Thursday March 16 Timed Finals [] 1 hr. before start of each session.
Friday March 17 Prelims [] Finals [] 1 hr. before start of each session.
Saturday March 18 Prelims [] Finals [] 1 hr. before start of each session.
Sunday March 19 Prelims [] Finals [] 1 hr. before start of each session.
Accepted applicants must attend mandatory officials’ briefings.
Expected Officials’ attire for the meet: white polo shirt, navy blue shorts, skirts, or long pants for all prelim sessions. White polo shirt and navy blue long pants or skirts for all final sessions. White tennis shoes are to be worn for all sessions.
SHIRT SIZE: (please check one) S M L XL 2XL 3XL
(This is for Host planning only and is not guaranteed)
Please Return Application to: Bill Rose, Meet Referee
4261 Lusk Drive
(916) 397-3628
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