GREATER PORTLAND SOCCER DISTRICT, INC

REFEREE REFUND CLAIM FORM

This form is for claiming a refund of the referee fee when a GPSD, Inc.  League sanctioned match has been scheduled and a referee does not arrive and referee the match.

NOTE: It is GPSD, Inc. policy that only one sanctioned match, during the current league season, with the referee missing will not be awarded a refund.

This form must be submitted to the Greater Portland Soccer District, Inc.  not later than 10 calendar days after the conclusion of the current league schedule. Mail completed form to: GPSD, INC., P.O. Box 271,  Otis Or 97368

After receipt of the claim form  GPSD, Inc. will investigate & review the claim. Any refund awarded will be paid only after the current league season for which a claim is made has ended.

Please provide the following information (* Required Fields):

* Division of play: -Select- Division 1 Division 2 Division 3 Over 30 2nd Over 30 3rd Over 40 1st Over 50 1st * Team Name: -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 * Team Manager: * Team Manager Email: Team Manager Phone: Enter the number in the format: xxx-xxx-xxxx Date of Match Match # Teams Missing Referee or Assistant Referee Home:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Away:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Home:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Away:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Home:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Away:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Home:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Away:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Home:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Away:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Home:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 Away:  -Select- Team Awesome SDFC Eastburn North End FC Portlandia FC Dinamo Bruins Athens SC Abysinnia Por Que No Marmots LIT Workshop FC Bridgetown O/30 The Onetouchables Ronler Hacres Mayday Joe Public FC 77 Bollocks Cascade Rangers FC SDFC Eastburn OM Highlanders Controlled Chaos AC Marrone Lager Legends Kingpins FC BridgePort FC 77 Rangers Rogues Random Assortment FC Widmer West Linn FC 77 PBR FC 77 Hibernian Celtic Portland FC Royals Rodders Pierres SC Nomads Gresham East FC 77 Old Nicks FC 77 Newcastle Fat Tuesday O/50 * Please enter the security Code: