Manitoba Soccer Referees Assocation – Registration
Name: Birthdate: / / (mm/dd/yy)
Address: Postal Code:
Phone #'s: (home)   (work)   (cell)
E-mail: Referee #: (n/a if not assigned)
 

Registration valid April 1st to March 31st.

Returning referees to register by April 1st. After April 1st, a late fee of $10.00 will apply. Please check

Please check one:
Senior Member ($40)
Associate Member ($15)		 MSRA Life Member (No Fee)

Please check one:
Renewal
New Member

* Note: The fee for New Members will be waived following the completion of 15 assignments.

 
What year did you first join MSRA?

If you refereed prior to becoming an MSRA member, please input the date.

Please indicate where you officiated and the level (youth or senior).

Please deduct my MSRA membership fee off my cheque.
If above box is not checked, you must submit a cheque payable to the 'Manitoba Soccer Referees Association' before receiving any assignments.

Please Note: MSRA Game levy, whether referee or assistant referee, is $1 off per assignment.

MSA Referee Development levy, whether referee or assistant referee, is $1 off per assignment.

 
Please answer the following questions and provide details for any question you answer with "yes".
1. Are you presently under suspension from any soccer authority? Yes   No
Details:
2. Are you now, or do you intend to be affiliated with any registered soccer club as:
a) a player Yes   No     b) board member/team official Yes   No
Team: League:
Division: Position:
I have completed the MSRA Membership Application accurately and honestly. As a member of the MSRA, I will abide by the by-laws of the MSRA along with its rules and regulations. I will abide by the MSRA and the CSA Code of Ethics at all times.

Privacy of Information: Personal information provided here will be used solely for the purposes of the MSRA, its members, other professional associations, and league officials for the purposes of communicating professional requirements and game assignment information. Leagues and associations will be reminded to respect the privacy and confidentiality of information provided. Any changes to this information, including any known loss, misuse, or disclosure to other 3rd parties is to be reported to the MSRA immediately.