Umpire Affiliation Ref#Umpire Personal DetailsName* First Last Address* Street Address City ZIP / Postal Code Email* Mobile Number*Home NumberMedical Conditions*Emergency Contact InformationName* First Last Home / Mobile Number*QualificationsPlease indicate your highest umpire qualification below.Umpire Qualification*Please selectNo qualificationCentre TheoryCentre PracticalZone TheoryZone PracticalNZ TheoryNZC PracticalNZB PracticalNZA PracticalIUAAre you up for re-endorsement this season, or has your endorsement lapsed?*Please selectYesNoAre you interested in sitting any theory exams this year?*Please selectYesNoTheory Exams interested in sitting in 2018Please selectCentre TheoryZone TheoryNZ TheoryWhat are you wanting to achieve out of umpiring this year?*CoachingAre you currently being coached by an Auckland Netball Umpire Coach?*YesNoWho is currently your coach?Umpire DevelopmentAre you interested in finding out more about the following:Umpire Pathways*YesNoUmpire Development Workshops*YesNoBecoming an Umpire Coach*YesNoAuckland Netball Umpire Academy*YesNoIf you have any feedback or suggestions please comment below:To the best of my knowledge, all information provided is true and correct. The above information is collected and held by Auckland Netball and will be used for the following purpose of administering Auckland Netball as per our constitution. Individuals have the right to access and correct information held by Auckland Netball. By submitting this form, I agree to abide by the Auckland Netball Centre Code of Conduct.I accept the umpire statement and terms and conditions as per above.* Yes No Umpire Affiliation 2018 Fee2018 Fee - $10.00Pay at Control RoomPhoto UploadYour photo should be of your head and shoulders - and please smile.