Formulaire de nomination des Championnats canadiens 2023

Championship Nominated For: (Required)

First Name (Required)

Last Name (Required)

Email (Required)

Phone (Required)

Address: (Required)

City (Required)

Province/Territory (Required)

Postal Code (Optional)

Gender Identity (Required)

Masculin

Féminin

Transgenre masculin

Transgenre féminin

non-binaire ou non répertorié

Size (jacket/shirt) (Required)

P

M

G

TG

Smoker/non-smoker (Required)

Certification Level and Year Attained (Required)

OuiNon

Seeking Level 4 Practical

OuiNon

National Umpire Exam - successfully completed for 2022.

List previous Championships (if any) (Optional)

Medical Issues (explain) (Required)

OuiNon

The umpire is nominated at U19 and above and has completed the fitness assessments.

Fitness testing was observed and verified by? (Optional)

OuiNon

Plate Squat Test Completed

27 Metre dash (time in secs - to tenth of a sec) (Optional)

Agility “T” Test (time in secs - to tenth of a sec) (Optional)

1000 Metre Run (minutes: seconds) (Optional)

Form completed by (PT UIC) (Required)