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Ground______________________________________ |
Date____________________________ |
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Game |
Referee
(Please Print) |
Centre
Touch |
Grade |
Teams |
Fee
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Signature |
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One |
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Two |
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Three |
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Four |
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This sheet is to be attached to the cheque & mailed to
P.O.Box 2193 Dangar, Newcastle West 2309 |
TOTAL: $________________________
Paid [ ] Not Paid [ ] |
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NEWCASTLE COALFIELDS RUGBY LEAGUE REFEREES
ABN 23 630 867 375 |
TAX
INVOICE |
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AMOUNT INCLUDING GST: $__________________________________ |
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RECEIVED / NOT RECEIVED AND ARE NOW DUE |
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FROM:_____________________________________________________ |
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REFEREES NAME: (Print)_____________________________________ |
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REFEREES SIGNATURE:_________________________ |
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