Please complete the following form, or
print a copy
and mail it to the address prodived. If you have any questions, please contact Tim Lively at 706-554-3552.
Judge's Name:
Address:
City:
State:
Zip Code:
Day Phone:
Alt. Phone:
Email Address:
KCBS Certified: Yes
No
KCBS Number:
Total number of KCBS events judges to date:
Last three KCBS events judged:
Master Judge: Yes
No
Certified Table Captain: Yes
No
Comments or Questions: