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Southeastern Connecticut Junior Soccer Association REFEREE PAYMENT FORM |
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Date: |
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Division: |
Select / Premier (Circle One) |
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Location: |
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Group: |
Boys / Girls (Circle One) |
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Age: |
11-12-13-14-15-16-17-18-19 (Circle One) |
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Referee |
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Asst Referee |
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Asst Referee |
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Authorized By: |
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New Referees |
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Name: |
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Address: |
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City: |
Zip: |
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Telephone: |
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SSN: |
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Name: |
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Address: |
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City: |
Zip: |
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Telephone: |
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SSN: |
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Mail this form for payment to: |
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