Conflict of Interest Disclosure for Referees

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1. Please provide your full name.

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2. Please provide your email address.

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3. Please list any soccer teams or organizations you are currently affiliated with.

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4. Do you have any direct family members Spouse (Children, Parents, Siblings
Grandparents and grandchildren) involved in soccer teams or organizations?

No

Yes

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5. If yes, please disclose any those conflicts including Name, Division and Team name.