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Referee Application / Registration

Referee – Registration

  1. Each participating referee will receive honorarium outlined below:
      • Non-Certified Referee – $50
      • USAT Certified D Level – $65
      • USAT Certified C Level – $80
      • USAT Certified B Level – $95
      • USAT Certified A Level – $110
      • International Referee (IR) – $130
      • USAT Certified Poomsae Referee will receive additional $10

    *Referees who bring in their own ipads with iPoomsae pre-loaded for the Competition Poomsae will receive additional $10. A total of 9 ipads will be needed.

  2. Referees must report to Master Danny Gonzalez, Referee Chairman, and attend the Referee Meeting on tournament day at 8:00 AM at the Toro Gym, Hospitality Room, CSU Dominguez Hills.
  3. Continental Breakfast, Lunch, and Dinner will be served.
  4. Only the first 50 referees will be accepted. Please register online or submit your application as early as possible!
  5. Referee Attire: Black color blazer and pants, White shirt, red tie and white shoes.

Be sure to fill out the USAT Referee Certification Seminar application or register online if attending on January 20, 2018.

Referee Information





        • Last Name (required)
          First Name (required)
          Address
          City
          State
          Zip
          Email (required)
          Phone
          Taekwondo School
          Gender MaleFemale
          Age
          Belt Rank
          USAT Referee Rank
          USAT Competition Poomsae Referee Rank
          Check all that apply:
          Center RefereeCorner JudgeCompetition PoomsaeCertified USAT Competition PoomsaeDinner after TournamentWill bring iPad for Competition Poomsae
          I agree to the Liability Waiver and Consent below: (required)
          YesNo

 

    • LIABILITY WAIVER AND CONSENT TO MEDICAL TREATMENT

I hereby submit this registration and liability waiver form to participate in the Yushen Lai’s Invitational Taekwondo Championship. I certify that the above information is true and correct and hereby release, discharge and waive any and all responsibility of the CSU, Dominguez Hills, Yushen Lai’s Taekwondo Academy, Tournament Committee, Referees, Instructors, and other competitors from liability for any injury, including death, and for damage to or loss of property which may be suffered by myself arising out of, or in any way resulting from or attributable in whole or in part to my traveling to, training for, being coached in, using any sports equipment in, or participating in the said event. As a competitor or parent/legal guardian of the competitor, I give consent to any x-ray exam, medical, chiropractic, dental or other treatment(s) deemed necessary for the safety and welfare of the contestant. I understand that this authorization is given prior to any diagnosis, treatments or hospital care being required, but is given to provide the medical/chiropractic/dental staff authority to render care as deemed advisable. In the case of minors, it is understood that efforts shall be made to contact the undersigned prior to rendering treatment, but treatment will not be withheld if the undersigned cannot be reached. I understand that in case of injury, only basic first aid will be made available on site, and that I am fully responsible for any and all resulting medical or other expenses. I release all rights to any photographs, video, audio, electronic images in which I or the minor appear and allow it to become the property of YLITC without compensation to be used, published, reproduced, distributed and other uses free of all claims and/or damages which may be incurred.

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