We are excited to welcome you to the National Blind Soccer Referee Summit in Chula Vista, CA. Please complete the form below to attend the referee summit at Chula Vista Olympic and Paralympic Training Center on Nov 7-11, 2024. This training will include referee certification and officiating games at the National Team Blind Soccer International Tournament. Arrival day is 11/6/2024 and departure is 11/11/2024. Contact Liesl Begnaud for any further questions LBegnaud@usaba.org.

Question Title

* 1. Full Name

Question Title

* 2. Organization You Represent

Question Title

* 3. Address Information

Question Title

* 4. Email Address

Question Title

* 5. Phone Number

Question Title

* 6. Preferred Contact (Call, Text, Email, Any

Question Title

* 7. Will you be requesting a travel scholarship? (up to $250 is available)

Question Title

* 8. If you would like to request reimbursement for travel expenses, up to $250.00, please book your own travel and provide a W9 and receipt to receive reimbursement

Question Title

* 9. Will you be staying on campus? On campus housing is provided by USABA 5 nights, Wednesday Nov. 6-Sunday Nov. 10th.
(If yes - rooms will be double occupancy)

Question Title

* 10. What experience do you have with blind soccer/overall soccer?

Question Title

* 11. Any medical issues that could occur during the coaching summit that we need to be aware of?

Question Title

* 12. Any other accommodations needed?

Question Title

* 13. T-Shirt size

Question Title

* 14. Meals are provided. Any food allergies or dietary needs?

Question Title

* 15. Prior to attending:

T