Referee Payment Form

Please fill out this form completely and accurately. This form allows submission of up to 10 games. Payments are processed within 5 business days as long as all referees submit this form. It is recommended all referees submit the day of the game(s). If you do not receive payment within that time frame, please email peternieto@mpschools.net.

PLEASE NOTE: ALL Referees for the games MUST submit in order for me to make payment for that game. For example, if 2 referees submit this form the night of the game and the 3rd referee does not submit until a week later, then all 3 referees will be paid when the 3rd referee submits his/her form. Do not delay. Submit this form immediately to prevent you from holding another referee's pay.

We are following the NMAA new "Travel Ring Fees" Schedule. When you choose the Travel Ring Fee option below, please choose the mileage that fits the one-way mileage distance from your home to the contest site. Each Official working the contest will receive a set rate based on the number of miles, one-way, from the Official’s home to the contest site.

Name*

First NameLast Name

Email*

example@example.com

Mailing Address*

Mailing Address Line 1

Mailing Address Line 2

CityState / Province

Postal / Zip Code

Is your Physical Address the same as your Mailing Address? *

Phone Number*

Please enter a valid phone number.

Date of Game(s)*

Date

Type of Payment

Driver (Full Mileage)

Split Mileage (Amount Split)

Choose City of Referee Driving the Furthest

Mileage Split by How Many Referees?

Name(s) of Other Referee(s) You Are Splitting With

Meal Per Diem

Choose Your Home Location $10.00 for 51-150 miles / $15.00 for 150+ miles

How Many Games Did You Referee on Above Date*

Game 1

Game 2

Game 3

Game 4

Game 5

Game 6

Game 7

Game 8

Game 9

Game 10

Travel Ring Fee*

Choose Mileage from Official's Home to Contest Site

Please Type In Physical Address for Travel Ring Fee Verification.

Signature