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MATCH CLAIM - Football Brisbane
Please complete the form for one of the following :
1.  Arrived at a ground and had to cancel the match due to Weather conditions
2.  Arrived at the ground and the club have closed the fields
3.  Arrived at the ground and ONE or NO TEAMS are present for kick off
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SURNAME *
FIRST NAME *
DATE OF MATCH *
MM
/
DD
/
YYYY
KICK OFF TIME *
Time
:
MATCH DETAILS *
Match details to include :
( ie:   U12 div 2 South )
Name of Ground and Venue *
Ground description
( ie: Albany Creek - Southpine 2 )
REASON for Claim *
Your Role *
Role Description
( ie : Referee / Assistant Referee )
AMOUNT CLAIMED $ *
Match fee claimed will be 50% of the match fee for the FIRST GAME ONLY if the game is cancelled before kick off.
COMMENTS if required ..
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