Southern Umpires Association Membership Renewal

General Information

Member number:

First Name:

*

Last Name:

*

Address:

*

Suburb:

*

Postcode:

*

Home phone:

*

Mobile:

*

Personal email:

*

Please advise of any change in circumstances, including medical conditions:

The accurate completion of the above section is crucial, failure to disclose any accurate or misleading information my preclude the payment of any compensation in the event of any injury or death.

Are you, or your immediate family, involved with any football clubs or other umpiring bodies:

If yes, what clubs:

Bank Account details

Account name:

Bank & Branch:

BSB No:

Account no:

Emergency Contact Information

Contact name:

Relationship:

Contact home phone:

Contact mobile phone:

Does the member have Ambulance cover?:

Is there any further information that may assist in the case of an emergency?:

Working with Children

All umpires over the age of 18 or who are turning 18 this football season are required by law to hold a Working with Children Check card. You are required to provide a copy of your application receipt before you can be appointed to umpire matches. Application forms are available from Australia Post or SUA.

Card number:

Expiry date:

Upload any attachments (max 1MB):

Umpiring Information

Umpire type:

*

How would you like to receive umpiring appointments:

*

Would you like to participate in the AFL Umpiring Mentor Program:

*

If yes, please select what size uniform you require:

Umpire Match Day Availability

Matches played: *

Friday Night
Saturday
Sunday
Weekdays

Additional information:

To assist with umpiring appointments do you need to umpire with an existing SUA umpire for transportation to matches:

*

If yes, who:

Assist with transportation of umpires to matches:

*

I shall accept such appointments and agree to be bound by the rules, contract and constitution of the Southern Umpires Association, for the period of my appointment. Copies can be supplied, or viewed on the SUA notice board. I agree to visit my sua supplied email / gmail account on a regular basis through out the season and acknowledge that official SUA communication including appointments will be automatically sent to this account. *

I am the parent/guardian of the above named, who is under 18 years of age. As the parent/guardian I am afforded the rights of Social Membership of the SUA. I have read this document, and consent to its terms and conditions for both the applicant and myself as a Social Member.

Name of parent/guardian:

Type the characters you see in the picture below.

Letters are not case sensitive

Membership Renewal Form

General Information

Emergency Contact Information

Working with Children

Umpiring Information

Umpire Match Day Availability

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