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Personal Information
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Your Name:
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Your Email:
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Your Phone:
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Your Club:
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Match Data
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Date of Match (mm/dd/yy): |
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Home Team:
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versus Visitors:
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Who won?
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Scoring
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Winning:
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Losing:
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Final Score:
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Trys Scored:
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Conversions Scored:
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Penalty Goals Scored:
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Drop Goals Scored:
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Medical Information
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Yes or No, Which of the following was available at the match?
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Ambulance:
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EMT:
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Trainer:
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Doctor:
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If any players were injured, please provide name and describe injury:
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Referee Information
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If any players were 'sent off' by the referee, please provide name:
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Name of referee:
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Comments about referee:
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Protest
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Was this match played under protest by your team?
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If yes, please provide details:
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* You must provide protest information in writing, within 72 hours, to the EPRU President, Secretary, and Divisional Play Chairperson. |
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Identify players from your's or your opponent's club you think might be candidates for the EPRU All-Star team.
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Name:
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Position:
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Email Address:
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Name:
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Position:
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Email Address:
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Name:
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Position:
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Email Address:
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