Checks/money orders (please no cash) payable to:   
Liberty Bell Football Officials Clinic

Mail to: (Enclose Check with Registration Form below)
Liberty Bell Football Officials Clinic
c/o Gerald Evans
1620 Melrose Avenue
Elkins Park, PA  19027-3158
evansjerr@gmail.com

LIBERTY BELL FOOTBALL OFFICIALS

CLINIC REGISTRATION FORM

            (April 1 Response Guarantees 2010 Video Mentoring Program Position)

Saturday, May 8, 2010

Ace Conference Center

Lafayette Hills, PA

Name ____________________________________                                                           

E-mail Address                                                                                                                       

Address_________________________City_______________State______Zip____          

Preferred Phone________________                                                                                     

Experience:  Indicate Number of years at "VARSITY" level

Years Sandlot_____ H.S. _____ DII/DIII_____  D1 FCS_____D1 FBS       _

Conference Affiliations_______________________________________________

Preferred Position [Circle One]:     R     U     HL     LJ     FJ     SJ     BJ    Obs/TA/ECO    

Shirt Size [Circle One]   S    M    L    XL    XXL         

Interest in Mentor Program [Circle One]     Yes        No____