Donald V. Andrews - Chairperson
228 Valley View Drive; Wallkill, NY 12589
Phone: 895-9309 Fax: 895-9309

Peter Meoli - Athletic Coordinator 50 Carlo Drive; Kerhonkson, NY 12446 Phone: 626-0062 Fax: 626-0062	Dennis Burkett – Assistant Chair Person 12 Enterprise Road, New Paltz 12561 Phone: 845-475-2565
Maria Meoli - Program Assistant 3 Countryman Lane Accord, NY 12404 Phone: 626-3245
Pat Meoli - Central Payments Coordinator

MHAL LATE START & ADDITIONAL FEE FORM

OFFICIALS NAMES: 1._ 2. _

DATE OF CONTEST: _____________________

SPORT: ________________________________ LEVEL: _______________________

HOME TEAM: ________________________ VISITORS: _________________________________

REASON FOR LATE START: ________________________________________________________

SCHEDULED START TIME: ____________ ACTUAL START TIME: ________________

WAS HOME TEAM NOTIFIED? ______ WAS VISITING TEAM NOTIFIED? _____

DID OFFICIALS SIGN HOME AND VISITORS SCOREBOOKS? ________

DID OFFICIALS PUT STARTING TIME IN SCOREBOOKS? ________

LIST REASON FOR ANY OTHER ADDITIONAL FEE.

________________________________________________________________________________

OFFICIAL’S SIGNATURE: ______________________________________________

OFFICIAL’S SIGNATURE: _______________________________________________

THIS SHEET MUST BE SENT TO PETE MEOLI WITHIN 5 DAYS OF THE CONTEST DATE OR PAYMENT CAN NOT BE MADE.