Nominee's Name*

Nominee's Email Address*

Nominee's State* Please select... ACT NSW QLD SA TAS VIC WA

Nominee's Mobile Phone Number*

Is this Nominee NOAS Accredited* Please select... Level 1 Level 2 Level 3 No they are not NOAS Accredited

Does this nominee have a current Boat Drivers Licence* Please select... Yes No

If this nominee has a current Boat Drivers Licence, please upload it here

Is this Umpire aspiring to become a Level 3 Umpire?* Please select... Yes No

Is this Umpire recommended for their Level 3 test?* Please select... Yes No

If they are recommended for their L3 test, have they completed their preliminary testing?* Please select... Yes No

Is this nominee a retiring umpire wishing to continue involvement in a mentoring role?* Please select... Yes No

Has this applicant previously worked as an STO at SIRR/ARC?* Please select... Yes No

Please indicate the days during the ARC this umpire is available for:*

Other Comments* Max. 255 characters

Name and Position of the person completing this form Max. 255 characters