Panther Basketball Officiating Camp

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Panther Basketball Officiating Camp
TMK Men’s Basketball Official’s Development/Tryout Registration Form
In the boxes below, put in numerical order the camps you would prefer to attend based on availability from 1 thru 4
Pittsburgh, PA Jamfest Session # 1 Fri. afternoon April 24th til Sat afternoon April 25th
Pittsburgh, PA Jamfest Session # 2 Sat. afternoon April 25th til Sun afternoon April 26th
Springfield, MA Session # 1 Fri. afternoon July 10th til Sat afternoon July 11th
Springfield, MA Session # 2 Sat. afternoon July 11th til Sun afternoon July 12th
Your Investment of $325 includes……
Camper’s will be evaluated on the court, and receive critiques by experienced NCAA D1 staff and tournament officials,
referee games played by the TOP AAU teams in the country and an evening social.
Campers will receive more info once your “REGISTRATION and CHECK” are received and accepted
Any questions please email Mike Kitts at:
[email protected]
(Please print CLEARLY)
__________________________________________________________________________
Last Name
First Name
__________________________________________________________________________
Address
__________________________________________________________________________
City
State
Zip
__________________________________________________________________________
Cell Phone:
Home Phone :
Work Phone:
_________________________________________________________________________
E-mail address:
__________________________________________________________________________
Emergency Contact:
Relationship:
Phone:
List your officiating experience for the past 5 years: ( HS Varsity, JUCO, D3, D2, D1)
________________________________________________________________________________________
________________________________________________________________________________________
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Make your Non-refundable “check
of $325 payable to T M Kitts”
______________________________________________________________________________________________________________
Signature:
Date:
Space is limited:
“First 35” Campers For Each Session Will Be Accepted, After That All Others Will Be Put On A Standby List.
Be sure to register early to guarantee your participation at the tryout.
Each registered camper will need to fill out a “Hold Harmless Agreement” and a “Declaration Concerning Prior
Disqualification Criminal Offenses” Forms
Please Complete the above registration form and mail it back along with your CHECK to:
TMK Basketball Officials
2040 Whisper Ridge Drive
Chittenango, NY 13037