* Denotes Required Input

Date*:

Title (Mr., Mrs.,etc.)*:

Name*:

Address*:

City*:

State*:

ZIP Code*: Plus 4:

Telephone Number (include area code)*:

Cell Phone Number (include area code):

Email*:

Local Camellia Club/Society:

ACS Member ID (if known):

Number of Years you have been an ACS Member*:

How many varieties do you grow?*:

How many varieties can you identify?*:

I attended the below Novice Judges' School

Novice Judges' School*:

Date Attended*:

List six shows in which you served as a Novice Judge and the name of one Accredited Judge on each judging team who judged with you in each show and who can certify to your competence as a judge.

May we publish your information on the ACS Website - Members Only Access?

Yes

Name, City, State & ZIP Code Only

No

I am a member in good standing of the American Camellia Society. If appointed I shall abide by the rules and regulations established by the ACS and printed in the Rules and Regulations Handbook, revised February 2008. By submitting this form I do hereby attest to the above information and make application to the American Camellia Society for appointment as an Accredited Judge.

In order to remain an Accredited Judge, each judge must every five years complete a refresher course and complete the “Judge Re-Accreditation Application” available on-line at the ACS website - www.americancamellias.org