ࡱ> Y  !(bjbjWW &z==!],,,,,,x4 4 4 4  rL$Xy  yy4 4 xy 4 4 ,,y4 L,vm,,: UNITED STATES SOCCER FEDERATION REFEREE REPORT This report must be mailed within 48 hours after completion of game to proper authorities. GAME: FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT   Home TeamScoreVisiting TeamScore State Association/Division/Professional League FORMTEXT      Age Group FORMTEXT       Date of Game: FORMTEXT      Scheduled time: FORMTEXT      Field: FORMTEXT      Actual kick off: FORMTEXT      Address: FORMTEXT      End of game: FORMTEXT       FORMTEXT      Score at half time: FORMTEXT    -  FORMTEXT     FORMCHECKBOX  H  FORMCHECKBOX  V REFEREE: FORMTEXT      Grade:  FORMTEXT   SSN: FORMTEXT    - FORMTEXT   - FORMTEXT     Sr. Assistant: FORMTEXT      Grade:  FORMTEXT   SSN: FORMTEXT    - FORMTEXT   - FORMTEXT     Jr. Assistant: FORMTEXT      Grade:  FORMTEXT   SSN: FORMTEXT    - FORMTEXT   - FORMTEXT     4th Official: FORMTEXT      Grade:  FORMTEXT   SSN: FORMTEXT    - FORMTEXT   - FORMTEXT      Field Condition: FORMTEXT      Weather: FORMTEXT      Was the home team on the field on time? FORMDROPDOWN If not, how late? FORMTEXT      No. of Spectators:  FORMTEXT       approx.Was the visiting team on the field on time? FORMDROPDOWN If not, how late? FORMTEXT      Marking of field:  FORMDROPDOWN Players Passes of the home team  FORMDROPDOWN  received and checked.Conduct of Officials: FORMDROPDOWN  Players Passes of the visiting team  FORMDROPDOWN  received and checked.of Players: FORMDROPDOWN Line-up of home team  FORMDROPDOWN of Spectators: FORMDROPDOWN Line-up of visiting team  FORMDROPDOWN Dressing room for Referee: FORMDROPDOWN 4th Official Game Log  FORMDROPDOWN for Players: FORMDROPDOWN A supplementary form explaining circumstances must accompany any unusual situations. Serious injuries during the game. NamePass No.TeamNature of Injury FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Players cautioned during the game. NamePass No.TeamType of Misconduct FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  Players sent off the field Player passes must be retained after the game and returned to proper authority with this report. NamePass No.TeamType of Misconduct FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN  I  FORMDROPDOWN  the referee fee of $  FORMTEXT    . FORMTEXT    Referee Signature: FORMTEXT      Phone #:( FORMTEXT 321)  FORMTEXT     - FORMTEXT     Date: FORMTEXT       For additional remarks use supplementary sheet. For serious assault, severe injury, or other substantial occurrences, a photo copy must be sent to Federation Headquarters: Fax: (312) 808-9572 Distribution: State Association / League / Referee 6/99  UNITED STATES SOCCER FEDERATION REFEREE SUPPLEMENTARY REPORT This report must be mailed within 48 hours after completion of game to proper authorities. A supplementary form explaining circumstances GAME: FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT   Home TeamScoreVisiting TeamScore State Association/Division/Professional League FORMTEXT      Age Group FORMTEXT       Date of Game: FORMTEXT      Referee: FORMTEXT        FORMTEXT       Describe Any Unusual Incident:  FORMTEXT       Remarks: Referee Signature: FORMTEXT       Report Date:  FORMTEXT       Phone #:( FORMTEXT 321)  FORMTEXT    - FORMTEXT      SSN: FORMTEXT     - FORMTEXT    - FORMTEXT      For serious assault, severe injury, or other substantial occurrences, a photo copy must be sent to Federation Headquarters: Fax: (312) 808-9572 Distribution: State Association / League / Referee 6/99 D`*,@BNPRTVjltvxz<>RV~j5Uj5U5CJCJj5Uj5Uj&5U 5mHnHj5U5 j5UB*6CJ5CJCJ jU<Dd*PTvx$$$$ ?*+D$&?*/+D  $&/1C/Dd*DNPTnrvx<>RTV~&*Jdnrt",0Jdnrtv . 0 X Z b d f h z   `<_]Z$L$$lֈ&(*$$$L$$lֈ*&(* <>RTV~*Jr6$$l\TJ*$$6$$l\TJ*$(*JL`bprt  .0JL`bptvx    . 0 2 4 : jT5Uj5Ujh5UjUj\5UjUjP5UjU jUjD5UCJ5 j5Uj5U9rt0Jr6$$l\*$6$$l\* rtvb d f h z J &d 6$$l\*$6$$l\*: < X Z \ h z |      " $ & : < > F H L j l j5Ujr5Uj5Uj5Uj5UmHnHj(5Uj5Uj<5UCJj5U5 j5U8   > F J L j  . 6 : < Z t ~   & * , H b l p ~     > X b f x :T^b:<@d~ bJ L j : < Z xL$$lֈ^z*$8$$l`^z*      * , . 6 8 < Z \ p r       & ( , . 2 H J ˕CJH*jt5Uj5Uj5Uj5Uj5UCJj>5Uj5U5j5UmHnH j5Uj^5U: * , H p ~    d_&d L$$lֈ^z*L$$lֈ^z*$ J ^ ` b l n p ~      > @ T V d f x z ުުުj 5CJUj 5CJU5CJj5CJUCJj5Uj45Uj5UjT5UCJj5UmHnH j5Uj5U56 > f x :b@d4D(7$$l^ r<*$$l r<*$$l r*$:<PR`b:<>@dfz|  JKYZ[]^顫鋫j%5Uj~$5CJUj#5U j5UjV#5CJUj"5CJUjR"5CJUj!5CJU5CJCJ5j5CJUjN!5CJU24J]^=XjkT^pz>@h*4FPvx>Xbf(,JLPRz@h b4J]^=XjkT^pz$d $$d  $$l r *$$$+,:;<XYghijkln߻ѯߥѕߋ6CJjd+5Ujr*5CJUCJH*j)5Uj(5CJUj(5Uj'5CJU5CJjh&5U5 j5UCJj5CJUj%5CJU3>@h*4FPvxDD<$$l  @ *$!$$l  @ * ,.0:<@BVXZdfhj~xzCJCJ j(/5Uj.5UjH.5Uj-5Ujh-5Uj,5Uj5UmHnHj,5U5 j5Uj,5U8,.<>@TVdfh|~*,j85Uj75Uj*75Uj45UjJ45Uj35Uj^35Uj05Uj~05Uj05U5 j5Uj/5U6>f,PRz@h*,<<<<<<$$$l  @ *,.JLNRThjxz|.02<>@BVXZdfhjjB5Uj@5Uj?5Uj5UmHnHj8?5Uj>5UjL<5Uj;5Ujl;5Uj:5Uj85U5 j5U5$&(,.BDFPRTVjlnxz|~(*8:<j&J5UCJCJCJ jG5UjFG5UjF5UjZF5UjC5UjzC5UjC5U5 j5Uj5UmHnH:*,T|:T^b|$&(FHLNv<d&(*Pjtx   "$.0246 * , 0 p r d!f!!!!!!!"" b,T|:b(LN<<<!$$l  @ * $$l  @ *$<PR`bdxz&(*FHJNPdfhrtvxj~R5UjR5Uj5UmHnHjQ5Uj2O5UjN5UjRN5UjM5Uj|K5UjK5U j5UjJ5U55Nv<d&(*Px 2< $$l*$$l  @ *$*,.8:<>RTV`bdf$&(j(Z5CJUjY5CJUjX5CJU5CJj5CJUCJjV5Uj4V5UjU5UjHU5UjR5U5 j5Uj5UmHnH3(*PRfhvx   "0246, . 0 p r b!d!f!!!!!ѿϵϫϡ 56CJ5CJ5CJCJ j\UCJ6CJ6CJ jR\5Uj[5Ujr[5U 5mHnHjZ5U5 j5UjZ5CJOJQJU5CJOJQJj5CJOJQJUCJ /246 * , 0 p r ~~v+D$&f)/+D  $&/1/  ($  ($N$$lֈ"$* d!f!!!!!""F"h"j"l""""""$L$$lֈ*dr(*$$$$$&f)/+D!!!!!""""" 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