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:

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