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Athletic Training Skill Check Off - Excel

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Athletic Training Skill Check Off - Excel Powered By Docstoc
					                                                Millard Athletic Association
                                                               4871 S 136th St Omaha NE 68137
                                                                PHONE: 894-1331 FAX: 763-9099

REQUESTORS CONTACT INFORMATION - CIRCLE ONE:                                               BB       SB         FB
                            Coach                                     Division                         Team


                              Check Payable To                                                Check Total Amount
                                                                                                       $0.00
                 Address                                      City                                       Zip


                   Date Check is Needed                                    Send out Check? Or Hold at Office?


                                          CATEGORY BREAKDOWN
                 Category                                             Description                                   Total
Awards, Trophies, Pins, etc                                                                                                 $0.00
Forfeit Fee                                                                                                                 $0.00
League Fees (i.e. USSSA)                                                                                                    $0.00
Meals/Ent                                                                                                                   $0.00
Paperwork, Office Supplies                                                                                                  $0.00
Pictures                                                                                                                    $0.00
Player Apparel/Uniforms                                                                                                     $0.00
Player Insurance                                                                                                            $0.00
Player/Team Equipment                                                                                                       $0.00
Practice Facility Rental                                                                                                    $0.00
Tournament Fees                                                                                                             $0.00
Training/Clinics                                                                                                            $0.00
Travel                                                                                                                      $0.00
Umpire Fees                                                                                                                 $0.00
                                                                                         Check Total                        $0.00
                                                  PLEASE NOTE
        **Check requests should be submitted by Tuesday in order to be signed and available on Friday**
         Please complete this form and attach to your receipts when submitting your request for a check.
    Requests can be dropped off at the office, faxed to 763-9099 or emailed to bookkeeper@millardathletics.com
    Should you need additional space to provide necessary information about your check request, please use the space below.
                                      Millard Athletic Association
                                            4871 S. 136th St.  Omaha NE  68137
                                                  894-1331  FAX: 763-9099


Circle Sport:     Baseball               Softball             Football

                                    Applicant Information
Last Name                    First Name                       MI

Address                      City                             Zip

Home Phone                   Secondary Phone                  E-Mail
                                                     Work
                                                      Cell
Birthdate                    SSN



                             Previous Officiating Experience
League                        Dates                            Level (age or skill level)




                    Previous Playing and/or Coaching Experience
League                        Dates                            Level (age or skill level)




                       Officiating Clinics/Workshops Attended
Clinic/Workshop                                               Dates




                               Most Recent Employment
Employer/Employer Phone      Dates Employed                   Position
                  6:50



or skill level)




or skill level)

				
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