World ParaVolley Level 2 Referee Course21-29 June 2020 – Šempeter, SLOVENIA

Candidate Application Form – Deadline April 1, 2020Course Fee Payment Deadline: April 30, 2020

(must be accepted into the course before making payment)

Participant’s Personal InformationFAMILY Name:       GIVEN Name(s):      Nationality:       Gender:      Passport #:       Expiry date:       Place of issue:      Date of Birth:       Place of Birth:      Profession:      Contact InformationPrimary Address:      Home Phone:       Mobile:      E-mail address:       SKYPE Name:      Languages Spoken:      Referee Information / Technical QualificationHighest Referee QualificationLevel:       Year:       Country:      Other Qualification / Experience

Year Location (country) Qualification / Experience                                                                    

AttachmentsResume / CV: Proof of Qualification:

Including statement ofPrior Learning

Statement: (refereeing & ParaVolley experience, career, reason for attending course)

I hereby confirm that all information provided above is true and correct. I will conform to the Rules & Regulations of the Course. I fully understand that my participation is at my own risk in all respect and will not hold World ParaVolley, ParaVolley Europe or the LOC responsible for any mishaps, accidents, etc. I promise to ensure the full fees as advertised in the invitation letter are paid, to complete the full duration of the course and to undergo all evaluations conducted.

I hereby confirm that I will purchase travel and medical insurance for the trip, which includes any enforced extension of my stay at the course, and that I will provide proof of insurance ahead of the course.

Participant Signature:       Date:      

p.1 Application Form – L2 Referee Course – Slovenia – 21-29 June, 2020

COURSE FEE OPTIONSPlease tick single or shared accommodation, and add extra nights & pay that amount

€340 per candidate (single room) €180 per candidate (shared room)

PLEASE NOTE: If there is an uneven number of candidates, there may not be a shared room option and you may have to be placed in a single room at the single room rate.

The above fee includes: World ParaVolley Registration fee of €100 (non-refundable); 8 nights’ accommodation; all meals; all transport from hotel to competition venue and return (and airport transfers); course materials; and instruction by a World ParaVolley educator.

Arrival Date: June 21, 2020Departure Date: June 29, 2020

Additional Nights: Should you wish to add more nights to your stay, please complete the information below: €100 per person (single room) €80 per person (shared room) # extra nights:       Dates:      

APPLICATION CERTIFICATION / VERIFICATION(by World ParaVolley Member, NPC, or National Volleyball Federation)

The World ParaVolley Member Nation, NPC or Volleyball Federation supports the above candidate to participate in the World ParaVolley Level 2 Referee Course – 21-29 June 2020, Šempeter, SLOVENIA.

      Official Seal of the WPV Member,NPC or National VB Federation

     

Federation Name:     

(Signature of Official)Name:      Function:      Date:      

IMPORTANT: Please return this fully completed form and credentials by e-mail by April 1, 2020Glynn Archibald, World ParaVolley Referee Commission ChairPierre Farmer, World ParaVolley Referee Commission SecretaryUna Dzalba, PVE Education CommissionerPhil Allen, World ParaVolley General Manager

referees@worldparavolley.orgpierre.farmer@sympatico.caeducation@paravolley.eugeneralmanager@worldparavolley.org

p.2 Application Form – L2 Referee Course – Slovenia – 21-29 June, 2020