WFTDA Expulsion-Suspension Form Expulsion-Suspension Form revision 170201

StatsBook 20082017 WFTDA

This form should be completed and signed for any expulsion in a game. Statements are not required and may be continued on the reverse side. All signatures certify receipt of the form and
one's own statement; it does not express agreement with the statement(s) of others. Any party who may, and chooses to, recommend a suspension should check the appropriate box next to
their contact information.
For WFTDA-sanctioned games, the expulsion must be recorded on the IGRF in the appropriate section. Return signed and completed Expulsion/Suspension forms to WFTDA Sanctioning with
the completed StatsBook and signed IGRF. These will be filed with the game documentation. If any party wishes to have an incident reviewed by the Games Review Panel (GRP), indicate this
on the IGRF at the time of signature. Any appeals may be filed with the WFTDA GRP at grievance@wftda.com.

Game Date: Teams Participating:

Suspension Recommended Below: YES | NO Meeting Results (if held):

Name of Official Witnessing the Action: Signature:

Official's Legal Name: League Affiliation: Penalty Issued:

Official's Contact Information:

Incident:

Head Referee Name: Signature:

Head Referee's Legal Name: League Affiliation: Suspension Recommended:

Head Referee's Contact Information: YES | NO

Comments:

Expelled Skater: Signature:

Skater's Legal Name: League Affiliation:

Skater's Contact Information:

Comments:

Home/Dark Team Captain Name: Signature:

Captain's Legal Name: League Affiliation: Suspension Recommended:

Captain's Contact Information: YES | NO

Comments:

Away/Light Team Captain Name: Signature:

Captain's Legal Name: League Affiliation: Suspension Recommended:

Captain's Contact Information: YES | NO

Comments:

FOR TOURNAMENT PLAY

Tournament Head Referee Name: Signature:

THR's Legal Name: League Affiliation: Suspension Recommended:

THR's Contact Information: YES | NO

Comments:

Games Official Name (if present): Signature:

GO's Legal Name: League Affiliation: Suspension Recommended:

GO's Contact Information: YES | NO

Comments: