MID-PENN CONFERENCE

CLOSED DATE SHEET 2001-2002

PLEASE RETURN BY JUNE 30, 2001: BOB RIBIC, 1307 GRUBB ROAD PALMYRA, PA 17078

NAME (Please Print) LAST, FIRST
ADDRESS CITY ZIP CODE
CELL PHONE
HOME PHONE *IF NEW PLEASE INDICATE NEW* BUSINESS PHONE EMAIL

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INFORMATION SHEET

NAME________________________________ Chapter______________________

Please Print

1. I will work Boys JV games if so classified.	Yes________	No________
2. I will work Girls JV games if so classified.	Yes________	No________
3. I will work Boys Varsity games if so classified.	Yes________	No________
4. I will work Girls Varsity games if so classified.	Yes________	No________
5. I will work 9^th Gd./Jr High games in the afternoon. What region? (1, 2 or 3) _______	Yes________	No________
6. I will work doubleheaders/tripleheaders	Yes________	No________
7. I will work Girls 9^th Gd./Jr. High games	Yes________ No________
8. I will work Boys 9^th Gd./Jr. High games.	Yes________	No________
9. In what town do you work?	________________________
10. What school did you attend?	________________________
11. Are you employed by a Mid-Penn school?	Yes________	No________
12. Do you have a connection with any school? List___________________________________	Yes________	No________

Please circle any school on the following list which you prefer NOT to be assigned next season.

Please explain. Alum., children. DISTANCE IS NOT TO BE CONSIDERED!

Explanation:___________________________________________________________________________________________

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