Referees Personal Officiating Record Form - Rackcdn.comc1940652.r52.cf0.rackcdn.com/...
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NZIHA REFEREES OFFICIATING RECORD NAME: ADDRESS:
DATE
Referee Level: . . . .
PERIOD: . . . . . . . . . . . . . . . . . . . . . . . . . . Scorers & Timekeepers please sign to verify the entry
VENUE
GAME No.
AGE GRADE
TEAMS
SCORER
TIMEKEEPER
The above is a true and accurate record of my officiating: Referees Signature: . . . . . . . . . . . . . . . . . . . . . . . POINTS TO REMEMBER: - Have the scorer and timekeeper verify your officiating. - Sign the form before posting. - Form must be received by Northern Region In-Line Committee Treasurer prior to the 10th of the following month to receive payment by the 30th of that month. - Treasurer & Address: For Treasurers Use: Level 1 Referee all games; Level 2 & 3 Referees all games;
. . . . . Games @ $10.00 = $ . . . . . . . . . . . . . . Games @ $15.00 = $ . . . . . . . . .
Total Amount Owing: $ . . . . . . . . . . . . . . Date Paid: . . . . . . . . . . . . . . . . Cheque No.: . . . . . . . . . . . . . . . .