Annual Referee Report Form

If you would like to be listed as a referee for 2022 competitions, please complete this form.

When you are finished with your form, please email or mail to the address indicated at the bottom of the document.

You may wish to print a blank form to complete by hand, or you may use the digital form below to download a completed copy.

Full Name
CPCA Number
Postal Code
Email Address
Phone Number
List your duties in 2021: Referee, Line Caller, Judge, or instructing.
Event Name & Date
Describe Function Preformed
Other Information i.e: PPC Instruction :
No referee card will be reissued until your 2022 CPCA Membership is paid.
Have you renewed your CPCA Membership?
Do you wish to be listed as a CPCA Referee for 2022?