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World ParaVolley Level 2 Referee Course21-29 June 2020 – Šempeter, SLOVENIA
Candidate Application Form – Deadline April 1, 2020Course Fee Payment Deadline: April 30, 2020
(must be accepted into the course before making payment)
Participant’s Personal InformationFAMILY Name: GIVEN Name(s): Nationality: Gender: Passport #: Expiry date: Place of issue: Date of Birth: Place of Birth: Profession: Contact InformationPrimary Address: Home Phone: Mobile: E-mail address: SKYPE Name: Languages Spoken: Referee Information / Technical QualificationHighest Referee QualificationLevel: Year: Country: Other Qualification / Experience
Year Location (country) Qualification / Experience
AttachmentsResume / CV: Proof of Qualification:
Including statement ofPrior Learning
Statement: (refereeing & ParaVolley experience, career, reason for attending course)
I hereby confirm that all information provided above is true and correct. I will conform to the Rules & Regulations of the Course. I fully understand that my participation is at my own risk in all respect and will not hold World ParaVolley, ParaVolley Europe or the LOC responsible for any mishaps, accidents, etc. I promise to ensure the full fees as advertised in the invitation letter are paid, to complete the full duration of the course and to undergo all evaluations conducted.
I hereby confirm that I will purchase travel and medical insurance for the trip, which includes any enforced extension of my stay at the course, and that I will provide proof of insurance ahead of the course.
Participant Signature: Date:
p.1 Application Form – L2 Referee Course – Slovenia – 21-29 June, 2020
COURSE FEE OPTIONSPlease tick single or shared accommodation, and add extra nights & pay that amount
€340 per candidate (single room) €180 per candidate (shared room)
PLEASE NOTE: If there is an uneven number of candidates, there may not be a shared room option and you may have to be placed in a single room at the single room rate.
The above fee includes: World ParaVolley Registration fee of €100 (non-refundable); 8 nights’ accommodation; all meals; all transport from hotel to competition venue and return (and airport transfers); course materials; and instruction by a World ParaVolley educator.
Arrival Date: June 21, 2020Departure Date: June 29, 2020
Additional Nights: Should you wish to add more nights to your stay, please complete the information below: €100 per person (single room) €80 per person (shared room) # extra nights: Dates:
APPLICATION CERTIFICATION / VERIFICATION(by World ParaVolley Member, NPC, or National Volleyball Federation)
The World ParaVolley Member Nation, NPC or Volleyball Federation supports the above candidate to participate in the World ParaVolley Level 2 Referee Course – 21-29 June 2020, Šempeter, SLOVENIA.
Official Seal of the WPV Member,NPC or National VB Federation
Federation Name:
(Signature of Official)Name: Function: Date:
IMPORTANT: Please return this fully completed form and credentials by e-mail by April 1, 2020Glynn Archibald, World ParaVolley Referee Commission ChairPierre Farmer, World ParaVolley Referee Commission SecretaryUna Dzalba, PVE Education CommissionerPhil Allen, World ParaVolley General Manager
[email protected]@[email protected]@worldparavolley.org
p.2 Application Form – L2 Referee Course – Slovenia – 21-29 June, 2020