E-Form: Update Official's Information

Page 1 of 3

Instructions:

Official's information can be updated by filling in the form below.
This form does not take the place of your annual registration with MVS; it merely makes it easier for us to correct or change your information in our database. Using this form does not meet any of the registration requirements set forth by USA Swimming and/or Missouri Valley Swimming.
You must be registered with MVS for the current year to be shown on our Registered Official's List.
Note that some fields below are required (indicated by asterisk).
Updates to NON-OFFICIALS' information must be submitted using the "Update Contact Information" form.

Your Information

= Required Field

Name

Address

City and State

Zip Code

Home Phone

(xxx-xxx-xxxx)

Work Phone

(xxx-xxx-xxxx)

Fax Number

(xxx-xxx-xxxx)

Club Affiliation

USAS Reg. Number

(010101FFFMLLLL)
(must match MVS records or form will NOT be accepted)

Are you currently
registered with MVS?

Yes No

Your Email Address

Stroke & Turn Certification

Update current
certification to:

No Change
LSC Certification (N1)
National Certification (N2)
National Championship Certification (N3)
DELETE this certification

Year Certification Expires

Check if you are currently a Trainee (TR)

Starter Certification

Update current
certification to:

No Change
LSC Certification (N1)
National Certification (N2)
National Championship Certification (N3)
DELETE this certification

Year Certification Expires

Check if you are currently a Trainee (TR)

Referee Certification

Update current
certification to:

No Change
LSC Certification (N1)
National Certification (N2)
National Championship Certification (N3)
DELETE this certification

Year Certification Expires

Check if you are currently a Trainee (TR)

Chief Judge Certification

Update current
certification to:

No Change
LSC Certification (N1)
National Certification (N2)
National Championship Certification (N3)
DELETE this certification

Year Certification Expires

Check if you are currently a Trainee (TR)

Admin Referee Certification

Update current
certification to:

No Change
LSC Certification (N1)
National Certification (N2)
National Championship Certification (N3)
DELETE this certification

Year Certification Expires

Check if you are currently a Trainee (TR)

Test Scores

Update Your Most
Recent Test Scores:

Type of Test	Score	Test Date
Timer:	%	(mo/yr)
Stroke & Turn:	%	(mo/yr)
Starter:	%	(mo/yr)
Referee:	%	(mo/yr)
Admin Referee:	%	(mo/yr)
Clerk of Course:	%	(mo/yr)
Timing Judge:	%	(mo/yr)

Most Recent Clinic Attended

Update Your Most
Recent Clinic:

Type of Clinic:
Clinic Code:	(eg. MV-09-ZZZ-##-##)
Clinic Date:	(01-01-09)
Location of Clinic:
Clinic Instructor:

Other Meets Worked

Swim Meet #1:

Name of Meet:
Meet Host:
Date of Meet:	(01-01-09)
Sanction Number:
Position Worked:
Number of Sessions:

Swim Meet #2:


Name of Meet:
Meet Host:
Date of Meet:	(01-01-09)
Sanction Number:
Position Worked:
Number of Sessions:

Swim Meet #3:


Name of Meet:
Meet Host:
Date of Meet:	(01-01-09)
Sanction Number:
Position Worked:
Number of Sessions:

Authorization to Display Contact Information

In accordance with the MVS Privacy Policy, certain contact information is not shown on this website unless specifically authorized by the member. Information that will not be shown includes your USAS registration number, street address, zip code and all telephone numbers (your USAS registration number is never shown even if you authorize all other information).

Indicate below whether to show your contact information on this website. To verify your identity, you MUST enter your USAS registration number above exactly as it's on file with Missouri Valley Swimming.

Display Information?

Authorized Not Authorized

E-Form: Update Official's Information

Page 1 of 3

Instructions:

Your Information

= Required Field

Name

Address

City and State

Zip Code

Home Phone

Work Phone

Fax Number

Club Affiliation

USAS Reg. Number

Are you currently registered with MVS?

Your Email Address

Stroke & Turn Certification

Update current certification to:

Starter Certification

Update current certification to:

Referee Certification

Update current certification to:

Chief Judge Certification

Update current certification to:

Admin Referee Certification

Update current certification to:

Test Scores

Update Your Most Recent Test Scores:

Type of Test

Score

Test Date

Most Recent Clinic Attended

Update Your Most Recent Clinic:

Other Meets Worked

Swim Meet #1:

Swim Meet #2:

Swim Meet #3:

Authorization to Display Contact Information

Display Information?

Include Other Information Below

Are you currently
registered with MVS?

Update current
certification to:

Update current
certification to:

Update current
certification to:

Update current
certification to:

Update current
certification to:

Update Your Most
Recent Test Scores:

Update Your Most
Recent Clinic: