Officials intent form
June 28 – July 3, 2011 Doug Shaw Memorial Stadium, Myrtle Beach, South Carolina
Name _______________________________________________________________________ Address ____________________________________________________________________ City ___________________________ State _______________________ Zip______________ Phone (Day) __________________________________ (Evening) ______________________ Email __________________________________ USATF Certification # _________________ Certification Level ________________________ Years of USATF Experience ___________ Have you officiated at a USATF National Youth Meet? Yes No
Shirt Size: S M L XL 2X 3X
Dates available: Tuesday, June 28, 2011
Wednesday 29, 2011 Thursday, June 30, 2011
Friday, July 1, 2011 Saturday, July 2, 2011 Sunday, July 3, 2011
Preferred Events (please list in order of preference – up to 3 events):
_____ SPRINTS _____ HURDLES _____ DISTANCE _____ THROWS _____ HIGH JUMP _____ LONG/TRIPLE JUMP _____ POLE VAULT _____ RACE WALK
Please provide any additional information you feel will be useful when considering your application:
Please fax to John Pedersen @ (843) 918-1028, or scan & email to jpedersen@cityofmyrtlebeach.com.