FFURFLEN GAIS

CWRS DYFARNWYR RYGBI CYFFWRDD LEFEL 1

LEVEL 1 TOUCH REFEREES APPLICATION FORM

25 ain o Fawrth 201212.00pm – 3.00pmYr Ysgubor, Parc y Scarlets

25th March 201212.00pm – 3.00pmBarn, Parc y Scarlets

Enw Name

Cyfeiriad E-bost Email Address

Cyfeiriad Address

Côd Post Post Code

Rhif ffôn Phone Number

Rhif ffôn symudol Mobile phone number

Rhif ffôn gwaith Work Phone Number

Disgrifiad byr o’ch cefndir dyfarnu a’ch cymwysterau

Brief description of your refereeing background and qualifications

CYFFWRDD SIR GÂR TOUCHUned Datblygu Chwaraeon Cyngor Sir Gâr Sports Development Unit Carmarthenshire County Council

Gwasanaethau Hamdden, Canolfan Adnoddau Busnes, Parc Amanwy, New Road, Rhydaman, SA18 3EP 01554 744 354 Leisure Services, Business Resources Centre, Parc Amanwy, New Road, Ammanford, SA18 3EP 01554 744 354

www.sirgar.gov.uk/cyffwrdd www.carmarthenshire.gov.uk/touch

Anfonwch y ffurflen i’r cyfeiriad isod gyda siec am £12.00 (gwnewch sieciau’n daladwy i ‘Cymdeithas Cyffwrdd Cymru’).

Y dyddiad cau o ran cofrestru yw dydd Mercher y 21ain o Fawrth 2012

Dalier sylw - Ni fyddwn yn rhoi ad-daliad heblaw eich bod yn rhoi gwybod inni o leiaf 48 awr ymlaen llaw.

Please send to below address along with a cheque for £12.00 (payable to Wales Touch Association)

Closing date for applications is Wednesday 21st March 2012

NB – refunds will not be given unless you give a

minimum of 48 hours notice

CYFFWRDD SIR GÂR TOUCHUned Datblygu Chwaraeon Cyngor Sir Gâr Sports Development Unit Carmarthenshire County Council

Gwasanaethau Hamdden, Canolfan Adnoddau Busnes, Parc Amanwy, New Road, Rhydaman, SA18 3EP 01554 744 354 Leisure Services, Business Resources Centre, Parc Amanwy, New Road, Ammanford, SA18 3EP 01554 744 354

www.sirgar.gov.uk/cyffwrdd www.carmarthenshire.gov.uk/touch