2019 Men’s Referee Availability Form – Club Fall 2019 Men's Club Availability Form First Name* Last Name* Full Name* Street or Mailing Address* City* State* Zip Code* Is this a new mailing address from what is currently on file with the league office?* Yes No Cell Phone Number* Home Phone Number Work Phone Number Primary E-mail Address* Secondary E-mail Address (if available) What is the best way to contact you?* (Select One) Email Cell Phone Home Phone Work Phone What is the best time of day to contact you?* (Select One) Anytime Mornings Afternoons Evenings Do you have an family member currently competing in water polo at the NCAA level (player or coach)?* (Select One) Yes No Please list the name, relation and institution of the family member here (if applicable) What is your Alma Mater (name of the institution and your class year)?* Are you currently married? (not required to answer) (Select One) Yes No Please provide your spouse's name here (not required to answer but we like having your spouse's name on file if there was a need for communication with them) Do you have an active NASO Membership (National Association of Sports Officials)* (Select One) Yes No Polo Shirt Size* (Select One) Unisex Small Unisex Medium Unisex Large Unisex X-Large Unisex 2XL Unisex 3XL Women's Small Women's Medium Women's Large Women's X-Large When completing your availability form it is imperative that you include your full last name, first initial and preference number for each event you select for that weekend. Example, John Smith’s first choice for a particular weekend should be listed as “Smith, J 1” and his second choice as “Smith, J 2” in the space provided after the event. If he is only selecting one event on a weekend it should still be listed as “Smith, J 1” in the space provided after that event. Sept. 14-15 (Sat.-Sun.) Big Ten Division East Region - TBD at either Univ. of Mich or Ohio State Univ. (10 gms) ~ Tentative Sept. 14-15 (Sat.-Sun.) Colonial Division - Worcester Polytechnic Institute, Worcester, MA (14 gms) Sept. 14-15 (Sat.-Sun.) Florida Division - Florida State University, Tallahassee, FL (16 gms) Sept. 14-15 (Sat.-Sun.) Great Lakes Division Regional - University of Cincinnati, Cincinnati, OH (8 gms) Sept. 14-15 (Sat.-Sun.) Heartland Division Regional - St. John's University, Collegeville, MN (8 gms) Sept. 14-15 (Sat.-Sun.) Missouri Valley Division - Rec Plex hosted by Lindenwood Univeristy, St. Peters, MO (14 gms) Sept. 14-15 (Sat.-Sun.) New York Division Crossover - US Military Academy, West Point, NY (24 gms) Sept. 14-15 (Sat.-Sun.) North Atlantic Division - University of Vermont, Burlington, VT (10 gms) ~ Tentative Sept. 21-22 (Sat.-Sun.) Atlantic Division - North Carolina State University, Raleigh, NC (10 gms) Sept. 21-22 (Sat.-Sun.) Great Lakes Division Regional - University of Notre Dame, Notre Dame, IN (10 gms) Sept. 21-22 (Sat.-Sun.) Mid-Atlantic "A" Division West Regional - Carnegie Mellon University, Pittsburgh, PA (8 gms) ~ Tentative Sept. 21-22 (Sat.-Sun.) Mid-Atlantic "B" Division - Albright College, Reading, PA (12 gms) ~ Tentative Sept. 21-22 (Sat.-Sun.) New England Division - TBD at either Univ. of Connecticut or Dartmouth College (14 gms) ~ Tentative Sept. 21-22 (Sat.-Sun.) Southeast Division - University of Tennessee, Knoxville, TN (20 gms) Sept. 28-29 (Sat.-Sun.) Atlantic Division - James Madison University, Harrisonburg, VA (10 gms) maybe Sept. 21-22 ~ Tentative Sept. 28-29 (Sat.-Sun.) Colonial Division - Wesleyan University, Middletown, CT (14 gms) Sept. 28-29 (Sat.-Sun.) Heartland Division Regional - Carleton College, Northfield, MN (12 gms) Sept. 28-29 (Sat.-Sun.) Mid-Atlantic "B" Division - Bloomsburg University, Bloomsburg, PA (10 gms) ~ Tentative Sept. 28-29 (Sat.-Sun.) Missouri Valley Division - St. Louis University, St. Louis, MO (14 gms) Sept. 28-29 (Sat.-Sun.) Rocky Mountain Division East Regional - University of Wyoming, Laramie, WY (12 gms) Sept. 28-29 (Sat.-Sun.) Rocky Mountain Division West Regional - Kearns Oquirrh Park Aquatic Center (Univ.of Utah), Kearns, UT (12 gms) Sept. 28-29 (Sat.-Sun.) Sierra Pacific Division - CSU Maritime Academy, Vallejo, CA (20 gms) Sept. 28-29 (Sat.-Sun.) Texas Division Crossover in Two Courses - Texas A&M University, College Station, TX (20 gms) Oct. 5-6 (Sat.-Sun.) Big Ten Division West Region - Univ. of Iowa, Iowa City, IA (10 gms) ~ Tentative Oct. 5-6 (Sat.-Sun.) Florida Division - University of Central Florida, Orlando, FL (16 gms) Oct. 5-6 (Sat.-Sun.) Great Lakes Division Crossover - University of Dayton, Dayton, OH (14 gms) Oct. 5-6 (Sat.-Sun.) Heartland Division Regional - Augustana College, Rock Island, IL (12 gms) Oct. 4-6 (Fri.-Sun.) Mid-Atlantic "A" Division Crossover - Univ. of Penn/Villanova Univ., Philadelphia/Villanova, PA (16 gms) ~ Tentative Oct. 5-6 (Sat.-Sun.) New England Division - Yale University, New Haven, CT (14 gms) Oct. 5-6 (Sat.-Sun.) New York Division West Regional - Hamilton College, Clinton, NY (14 gms) Oct. 5-6 (Sat.-Sun.) New York Division East Region - Rensselaer Polytechnic Inst., Troy, NY (10 gms) ~ Tentative Oct. 5-6 (Sat.-Sun.) North Atlantic Division - Colby College, Waterville, ME (10 gms) ~ Tentative Oct. 5-6 (Sat.-Sun.) Northwest Division - Osborn Aquatic Center hosted by Oregon State Univ., Corvallis, OR (10 gms) Oct. 5-6 (Sat.-Sun.) Pacific Coast Division - TBD (14 gms) ~ No Site Tentatively Confirmed due to Varsity Scheduling Oct. 5-6 (Sat.-Sun.) Southeast Division - TBD (20 gms) ~ No Site Tentatively Confirmed due to Pool Scheduling Oct. 5-6 (Sat.-Sun.) Southwest Division - TBD at either Univ. of Arizona or UC Irvine (16 gms) ~Tentative Oct. 5-6 (Sat.-Sun.) Texas Division East Region - Rice University, Houston, TX (10 gms) Oct. 12-13 (Sat.-Sun.) Atlantic Division - University of Maryland, College Park, MD (16 gms) ~ Tentative Oct. 12-13 (Sat.-Sun.) Heartland Division Champs - Macalester College, St. Paul, MN (12 gms) Oct. 12-13 (Sat.-Sun.) Missouri Valley Division Champs - Washington University in St. Louis, St. Louis, MO (11 gms) Oct. 12-13 or Oct. 19-20 (Sat.-Sun.) Northwest Division - TBD (10 gms) ~ Tentative Oct. 12-13 (Sat.-Sun.) Pacific Coast Division - Cal Poly State University, San Luis Obispo, CA (14 gms) ~ Tentative Oct. 11-13 (Fri.-Sun.) Rocky Mountain Division Crossover - Colorado Mesa University, Grand Junction, CO (24 gms) Oct. 12-13 (Sat.-Sun.) Sierra Pacific Division - TBD (20 gms) ~ No Site Tentatively Confirmed due to Varsity Scheduling Oct. 12-13 (Sat.-Sun.) Southwest Division - TBD at either Univ. of Arizona or San Diego State Univ. (16 gms) ~ Tentative Oct. 12-13 (Sat.-Sun.) Texas Division West Region - Texas Tech University, Lubbock, TX (10 gms) Oct. 19-20 (Sat.-Sun.) Big Ten Division Crossover - Indiana University, Bloomington, IN (16 gms) ~ Tentative Oct. 19-20 (Sat.-Sun.) Colonial Division Champs - Middlebury College, Middlebury, VT (11 gms) Oct. 19-20 (Sat. -Sun.) Mid-Atlantic "B" Division Champs - West Chester University, West Chester, PA (11 gms) ~ Tentative Oct. 19-20 (Sat.-Sun.) New England Division Champs - Boston University, Boston, MA (11 gms) Oct. 19-20 (Sat.-Sun.) New York Division Champs - Cornell University, Ithaca, NY (18 gms) ~ Tentative Oct. 19-20 (Sat.-Sun.) North Atlantic Division Champs - Bowdoin College, Brunswick, ME (8 gms) ~ Tentative Oct. 19-20 (Sat.-Sun.) Texas Division Champs - Rice University, Houston, TX (15 gms) Oct. 26-27 (Sat.-Sun.) Atlantic Division Champs - US Naval Academy, Annapolis, MD (15 gms) Oct. 26-27 (Sat.-Sun.) Florida Division Champs - University of Florida, Gainesville, FL (12 gms) Oct. 26-27 (Sat.-Sun.) Great Lakes Division Champs - Davenport University, Grand Rapids, MI (12 gms) Oct. 26-27 or Nov. 2-3 (Sat.-Sun.) Northwest Division Champs -TBD (10 gms) ~ Tentative Oct. 26-27 or Nov. 2-3 (Sat.-Sun.) Pacific Coast Division - TBD (14 gms) ~ No Site Tentatively Confirmed due to Varsity Scheduling Oct. 26-27 (Sat.-Sun.) Rocky Mountain Division Champs - VMAC (Univ. of Colorado), Thornton, CO (18 gms) Oct. 26-27 (Sat.-Sun.) Sierra Pacific Division Champs - Univ. of California - Santa Cruz, Santa Cruz, CA (15 gms) Oct. 26-27 or Nov. 2-3 (Sat.-Sun.) Southeast Division Champs - TBD (15 gms) ~ No Site Tentatively Confirmed due to Pool Scheduling Oct. 26-27 (Sat.-Sun.) Southwest Division Champs- Univ. of California-San Diego, San Diego, CA (12 gms) Oct. 26-27 (Sat.-Sun.) Division III National Collegiate Club Champs - TBD (Selection) Nov. 2-3 (Sat.-Sun.) Big Ten Division Championship - TBD at either Univ. of Mich or Indiana Univ. (15 gms) ~ Tentative Nov. 2-3 (Sat.-Sun.) Mid-Atlantic "A" Division Champs - Penn State University, State College, PA (12 gms) ~ Tentative Nov. 15-17 (Fri.-Sun.) National Collegiate Club Champs - University of Pittsburgh, Pittsburgh, PA (Selection) Please Note: The Mid-Atlantic "A" & "B" Division Single Night Games will be released seperately but please list your name here if you are interested in being assigned. If you confirmed you filled out your contact information properly and also selected all sites you are available, please click the below submit button in order for your form to be received. If done properly, you will be redirected to the Officiating Forms page. Submit Club Referee Form