US Lacrosse Women’s Official Transfer Form

Instructions for relocating official: Complete your part of form and send to your current Local Board Chair. You must also contact US Lacrosse, notifying them of this Local Board transfer. ()

Instructions for official’s current Local Board Chair: Verify rating and rating expiration date. IF this is an out of region transfer by an official with a District, National, or International rating, send this form to the Region Chair for verification of region service. They will return it to you and you will then send this form to the new Local Board Chair and e-mail the relocating official the name and contact information of their new Local Board Chair.

Instructions for official’s current Region Chair: Verify the status of the relocating official’s service credits. Send the completed form back to the official’s current Local Board Chair.

Relocating Official – Please fill out the following

Name / First Name / Last Name / Relocation Date / Date
Member # / USL ID# / Rating / Select / Expiration Date / Date

Previous information:

Address / Street
City / City / State / State / Zip / Zip Code
Local Board / LB Name / Board Chair / First Name / Last Name
Email / Primary Email
Address / Street
City / City / State / State / Zip / Zip Code

New information:

Address / Street
City / City / State / State / Zip / Zip Code
Local Board / LB Name

Previous Local Board Chair – Please confirm rating and local board service

Rating / Select / Received / Date
SERVICE COMPLETED AT THE LOCAL LEVEL / ☐ / Yes / ☐ / No
Please enclose the service requirements of your board
Board Chair Signature / Sign Here

If Appropriate – Previous Region Chair - Please confirm officials region service credit status

Previous Region / Enter Region
SERVICE COMPLETED AT THE REGION LEVEL / ☐ / Yes / ☐ / No
Please enclose the service requirements of your region
Board Chair Signature / Sign Here