EASTERN PENNSYLVANIA SOCCER ASSOCIATION
Referee Committee
Affiliated with the United States Soccer Federation
Application for Entry Level Referee School
Complete all areas of the application and return with payment as instructed below. Class is limited to 30 students, you will be notified by email if you are in the class or on a waiting list.
Once accepted for class on the dates advertised no refunds will be given so make sure you are available to participate.
Students MUST attend all classes and pass the written exam to be certified!
PLEASE PRINT CLEARLY.
Last Name:
First Name:
Middle Initial:
Street Address:
City: State: Zip:
Phones------Home: Work: Cell:
Date of Birth:
(You must be at least 14 years old when taking the course)
email address:
Club Affiliation (If any):
The Entry-Level Referee School fee is $70.00 for all candidates. This includes all material for the course, hours of instruction, and your first year’s registration with the USSF. Your check should be made payable to EPSARC and must accompany this application. The classes will be filled on a first come, first serve basis with 30 students being the maximum class size.
Please return your check made payable to EPSARC and application to:
USSF Referee Course
C/O Dwayne Arehart
1309 Church St.
Lititz, PA 17543