2016-17 Brainerd High School Athletic Officials Voucher for Payment of Services
Date of Contest *
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Sport or Activity: *
Opponent:: *
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Level of Competition: *
Check "Other" to add details about contest (e.g. Dual, 5th Quarter, etc)
Round Trip Mileage (Varsity Officials only):
*Mileage to be paid for one vehicle per contest.*
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Official's Last Name: *
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Official's First Name: *
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Official's Address: *
You may enter "On File" if you have filled out a voucher for payment during this school year
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Phone Number *
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Email Address: *
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Social Security Number *
You may enter "On File" if you have previously submitted your SSN on an officials voucher this school year.
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