Certified Judge Application Please complete the following information to be considered for a Rally Freestyle Elements Judge. Please note that if approved, the contact information below will be listed in the Judges Directory. Date MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website Phone*Alternate PhoneEmail* QualificationsAnswers should be brief, yet informative. List other sports that you currently are certified to judge.If you have titled in Canine Musical Freestyle or Rally, please list the highest titles and year achieved.List any clubs, classes, businesses you have served as a trainer, assistant trainer, occasional trainer or training director.List any seminars and/or workshops you have attended in preparation to judge Rally FrEe (these do not need to be Rally FrEe seminars/workshops).List names, phone and email addresses for any approved judges who may be used as a personal reference.Provide any information not requested that supports or supplements your background.CertificationI HEREBY submit my application to RALLY FREESTYLE ELEMENTS (RFE) for its consideration and make the following certifications:I certify that I am familiar with the RFE's Rules, Regulations, Policies and Judges' Guidelines, and I agree to abide by them. I certify that if granted judging status, I fully understand that my judging eligibility is conditional and, therefore, reviewable at any time subsequent to the date the status was initially granted. I certify that upon review, RFE may relieve me of continued judging eligibility. I certify that I understand and acknowledge that if I am charged with cruelty, inhumane treatment of animals, or similar offense involvinginhumane or cruel treatment of dogs, or charged with any crime involving moral turpitude, especially as it concerns dog-related activities, RFE may temporarily place my judging privileges on referral while the charges are pending. Further, after receiving notification of the referral, I am prevented from judging or from accepting assignments to judge. When the charges are resolved and RFE's inquiry into the matter determines that no action will be taken by RFE to cause a suspension of my judging privileges, the temporary judging referral will be removed. Submittal Confirmation* By checking here, I certify that I have read and agree to the terms and conditions of the above Certification and that all information submitted in this application is truthful and accurate. NameThis field is for validation purposes and should be left unchanged. Δ
