• Membership Application for the Ventura Chapter of the

    Southern California Soccer Referee Association (SCSRA)

    Please fill out this application and print it once you submit the form.  Incomplete applications may be rejected. Please make your dues check payable to SCSRA-Ventura and mail it with the signed application to: Bruce Russell at 1742 Caballero St., Simi Valley, CA, 93065-4814.  (805) 433-2010

  • Date Format: MM slash DD slash YYYY
  • Required to Receive Game Assignments
  • Date Format: MM slash DD slash YYYY
  • Please enter a number greater than or equal to 1.
  • By signing this application, I affirm that the above information is correct. I further agree to abide by the USSF Referee Code of Ethics and this Association's Constitution, By–Laws, Policies, and Operating Procedures
  • Date Format: MM slash DD slash YYYY
  • For Office Use

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