2024 Field State Championship Umpires - Hockey NSW

Association*

Championship*

Team 1

Team 1 (eg Bathurst 1(Boys))*

Team 1 Umpire Name*

Team 1 Umpire DOB*

Team 1 Umpire Contact Number*

Team 1 Umpire Email*

Team 1 Umpire WWCC (if over 18 years old)

Team 1 Relevant Experience (Dot Form)*

Team 2

Team 2 (Name)

Team 2 Umpire Name

Team 2 Umpire DOB

Team 2 Umpire Contact Number

Team 2 Umpire Email

Team 2 Umpire WWCC (if over 18 years old)

Team 2 Relevant Experience (Dot Form)

Team 3

Team 3 (Name)

Team 3 Umpire Name

Team 3 Umpire DOB

Team 3 Umpire Contact Number

Team 3 Umpire Email

Team 3 Umpire WWCC (if over 18 years old)

Team 3 Relevant Experience (Dot Form)

Notes