Western Region Ringette - 2009 Officiating Clinic Request Form

Name:		Association	Select Association Chatham Dorchester Elora/Fergus Exeter Forest Goderich Guelph Hanover Independent Kitchener London Mitchell Owen Sound Seaforth St. Clements St. Jacobs St. Marys St. Thomas Stratford S.W.I.R.L. Tara Tillsonburg Waterloo Wellington North Woolwich Other - Out of Region
Email:		Phone Number
ORA Number		Current Referee card level

I agree to purchase a Case Book ($25) at the clinic	Yes No
Recommended for Level 1

Clinic Requested

Select from the following clinics Level 1 Waterloo – Sat. Oct. 3rd Rim Park Level 1 Goderich - Sat Oct 17th Knights of Columbus Center Level 2/3 London – Sat. Oct. 24th North London Community Center Level 2/3 Waterloo – Sat. Nov. 14th Rim Park

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