http://www.newtonsoccer.org/images/home.gif      NYS Travel Referee Payment Form – Spring

Note:  Not an Internet Explorer user or if this file is not visible or not clear, please use the attached file in PDF format.

 Please complete prior or after printing and mail the form to NYS treasurer for payment.

http://www.newtonsoccer.org/ref_pa1.gif Referee Information

First and Last name

Phone:

Street address

Zip:

http://www.newtonsoccer.org/ref_pa1.gif  Game Information:

         Date:                           Time:                                                  Field:

        Home Team:                                                                           Visiting Team:    

Home Coach Name and Signature:

 

  http://www.newtonsoccer.org/ref_pa1.gif   Payment Category (Please select and circle the associated $$ amount)

 

 

 

Referee:

 

 

All referees paid by BAYS in the Spring season

 

 

Assistant Ref:

 

 

  

 

 

U-11/U-12   $20

 

 

U-14            $25

 

 

 

 

Referee Assigner:    John McKenna    (617) 870-5947

http://www.newtonsoccer.org/ref_pa1.gif Mailing Information:

Jeff Kalowski

NYS Treasurer

22 Halcyon Road

Newton , MA 02459

 

http://www.newtonsoccer.org/ref_pa1.gif Referee Report:

 

 

Was the Zero Tolerance Policy well observed?

 

 

Comments:

(Use reverse side if needed)

 

 

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            Newton Field Hotline: 617-928-6061