2016-17 Brainerd High School Athletic Officials Voucher for Payment of Services
Date of Contest
MM/DD/YYYY
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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)
Required
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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