UMPIRING COURSES REGISTRATION FORM
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Complete Course Registration Form and send to your regional hockey office no later than 21 days
prior to the Course start date.
Regional Office will ‘sign-off’ the form (pending suitability of venue, tutor, number of participants etc.)
and then send it by e-mail or fax to the Umpiring Development Administrator at England Hockey Board.
Please note ALL tutors MUST be in possession of a current EHB CRB.
The Administrator will dispatch the resources and the supporting invoice within 3 working days of
receiving the authorized registration form. The resources shall be sent to the delivery address as stated
below. The invoice will be sent to the invoice address as stated below. Payment is required within 14
working days of the invoice issue date.
Please note that resources cannot be returned / refunded. It is the responsibility of the Course
Organizer to order the exact number required (in accordance with the number of candidates registered).
Course type (please tick box)
NUMBER REQUIRED
YOUNG UMPIRE AWARD
FOUNDATION UMPIRE
LEVEL 1 UMPIRE
25
COST PER RESOURCE PACK
£6.50 PER RESOURCE PACK
£10 PER RESOURCE PACK
£27.50 PER RESOURCE PACK
TOTAL PRICE
687.50
Course Organiser details
NAME OF COURSE ORGANISER: Barrington Sports North West Hockey League
DELIVERY ADDRESS: c/o Brian Linfield
INVOICE/RECEIPT ADDRESS: BSNWHL UMP 02
NAME: Jon Hodges
151 Todmorden Road
Burnley
Treasurer – North West Hockey League
Lancashire
27 Hulton Close
POST CODE: BB11 3HA
DAYTIME TEL. NO: 01282719344
EMAIL ADDRESS: [email protected]
Congleton
Cheshire
POST CODE: CW12 3TF
Course / Tutor details:
NAME OF COURSE TUTOR: Mr Brian Linfield
COURSE DATES/TIMES: (Please provide a full schedule) Sunday 28th October 2012 1000hrs to 1800hrs
COURSE VENUE: The Northern Lawn tennis Club, Palatine Road, Didsbury, Manchester. M20 3YA
EMAIL ADDRESS: [email protected]
COST OF COURSE TO CANDIDATES: £ 45.00
NUMBER OF CANDIDATES REGISTERED: 0 but have room for 40
candidates
NUMBER OF RESOURCES REQUIRED:
Please ensure that you order the correct number of resources. Postage and packing will be charged at a rate of £3.50 per resources
pack for any late / additional order. Thank you.
Confirmation
I confirm that the information given on this form is correct and that I am responsible for notifying EHB of any change/s. I understand
that a representative or staff member of EHB or other organisation associated with EHB, may visit the course or assessment sessions
for quality control purposes at any time. I also understand that this is a national governing body accreditation and I am required to
deliver the published syllabus in accordance with the published guidelines. I agree to abide by those guidelines at all times.
Sign & Print Name: Mike McDonagh
Date: 18th September 2012
December 2011
RDM USE ONLY
Approved by (name of Regional Administrator:
Date approved:
Sent by fax or e-mail (please report):
DDA use only
Course Registration Number:
Date of despatch and invoice: