Referee Availability Form Eddie Pena-USSF Referee Assignor P.O. Box 270394 Tampa, FL 33688 Phone: 813-961-7701 Fax: 813-961-7701 Email: Epena5@tampabay.rr.com Website: http://www.edpena.net To submit online, log on to http://www.edpena.net Last Name: ____________________________ First Name: _________________________________ Address: _______________________________________________ City: ___________________ State: ________ Zip: _________ Date of Birth ___________ Gender Male ____ Female ____ FYSA Certified: Yes __ NO __ USSF Registered: yes __ or No __ Current Referee Grade: _____ Date Attained: ________ Phone Cell:(___) ____-_____ Home: (___) ____-_____ Work: (___) ____-_____ Email: _____________________________________________ Fax: (___) ____-_____ If affiliated with a Club: ____________________________________ Team: ________________________ Division: ______ Age Group: _____ Days and Times you are available: ******************************************************************** Nov 20 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Dec 4 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Dec 11 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Jan 22 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Jan 29 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Feb 5 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Apr 9 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields Apr 16 AM ____ PM ____ at CF KRAZE/KRUSH at FSA Fields ******************************************************************** Nov 6 AM ____ PM ____ Brandon AM ____ PM ____ Clearwater AM ____ PM ____ HCU AM ____ PM ____ Sarasota AM ____ PM ____ Strictly Nov 7 AM ____ PM ____ Brandon Nov 13 AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ HCU AM ____ PM ____ IMG AM ____ PM ____ Strictly Nov 14 AM ____ PM ____ Lakeland Nov 20 AM ____ PM ____ Brandon AM ____ PM ____ Clearwater AM ____ PM ____ IMG AM ____ PM ____ RSL AM ____ PM ____ Sarasota Dec 4 AM ____ PM ____ Fusion FC AM ____ PM ____ HCU AM ____ PM ____ Lakeland AM ____ PM ____ Sarasota Dec 5 AM ____ PM ____ Lakeland AM ____ PM ____ RSL Dec 11 AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ HCU AM ____ PM ____ Lakeland Dec 15 AM ____ PM ____ Fusion Dec 18 AM ____ PM ____ Brandon AM ____ PM ____ Clearwater AM ____ PM ____ HCU AM ____ PM ____ IMG AM ____ PM ____ Sarasota Jan 8 AM ____ PM ____ Brandon AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ Sarasota AM ____ PM ____ Strictly Jan 15 AM ____ PM ____ Brandon AM ____ PM ____ Clearwater AM ____ PM ____ HCU AM ____ PM ____ Lakeland AM ____ PM ____ RSL Jan 22 AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ HCU AM ____ PM ____ RSL AM ____ PM ____ Strictly Jan 29 AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ HCU AM ____ PM ____ IMG AM ____ PM ____ Lakeland Jan 30 AM ____ PM ____ RSL Feb 5 AM ____ PM ____ Clearwater AM ____ PM ____ Sarasota AM ____ PM ____ Brandon AM ____ PM ____ RSL AM ____ PM ____ HCU Feb 12 AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ Strictly AM ____ PM ____ HCU AM ____ PM ____ Lakeland Mar 5 AM ____ PM ____ Clearwater AM ____ PM ____ Brandon AM ____ PM ____ HCU AM ____ PM ____ Strictly AM ____ PM ____ IMG Mar 6 AM ____ PM ____ Lakeland Mar 19 AM ____ PM ____ Brandon AM ____ PM ____ Sarasota AM ____ PM ____ Strictly AM ____ PM ____ HCU AM ____ PM ____ Clearwater AM ____ PM ____ RSL Apr 3 AM ____ PM ____ Scrictly Apr 9 AM ____ PM ____ Lakeland AM ____ PM ____ Fusion AM ____ PM ____ RSL AM ____ PM ____ Clearwater Apr 16 AM ____ PM ____ IMG AM ____ PM ____ HCU AM ____ PM ____ Lakeland AM ____ PM ____ RSL May 7 AM ____ PM ____ HCU AM ____ PM ____ Sarasota AM ____ PM ____ Clearwater AM ____ PM ____ Fusion AM ____ PM ____ Strictly AM ____ PM ____ IMG May 14 AM ____ PM ____ IMG AM ____ PM ____ Lakeland AM ____ PM ____ Brandon AM ____ PM ____ Sarasota AM ____ PM ____ Clearwater ******************************************************************** Game fees : U09-10: Ref $22 U11-14: Ref $44, AR’s $22 Ed Pena's Tournaments: Largo Halloween Tournament October 22-24, 2010 Clearwater Thanksgiving Challenge November 27-28, 2010 IMG Cup - Boys' Invitational December 11 - 13, 2010 Region C Cup February , 2011 March Madness Shootout March , 2011 IMG Cup – Girls’ Invitational Tournament April 1 – 3, 2011 International Easter Tournament April 23-24, 2011 Tampa/St. Pete 3v3 Super Challenge May , 2011 USL Beach Soccer Tournament July , 2011 SCI Labor Day Cup Presented by Nike September , 2011 HCU Adidas Columbus Day Classic October , 2011