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Personal Information
Your Name:
Your Email:
Your Phone:
Your Club:		Albright College Women Bloomsburg University Women Bryn Mawr-Haverford College Women Bucknell University Women College of New Jersey Women Drexel University Women East Stroudsburg University Women Franklin & Marshall College Women Gettysburg College Women Kutztown University Women Lafayette College Women LaSalle University Women Lebanon Valley College Women Lehigh University Women Lock Haven University Women Millersville University Women Muhlenberg College Women Penn State University Women Princeton University Women Saint Joseph's University Women Shippensburg University Women Susquehanna University Women Swarthmore College Women Temple University Women University of Delaware Women University of Pennsylvania Women University of Scranton Women Ursinus College Women West Chester University Women Widener University Women York College Women -select from the list-
Match Data
Date of Match (mm/dd/yy):
Home Team:		Albright College Women Bloomsburg University Women Bryn Mawr-Haverford College Women Bucknell University Women College of New Jersey Women Drexel University Women East Stroudsburg University Women Franklin & Marshall College Women Gettysburg College Women Kutztown University Women Lafayette College Women LaSalle University Women Lebanon Valley College Women Lehigh University Women Lock Haven University Women Millersville University Women Muhlenberg College Women Penn State University Women Princeton University Women Saint Joseph's University Women Shippensburg University Women Susquehanna University Women Swarthmore College Women Temple University Women University of Delaware Women University of Pennsylvania Women University of Scranton Women Ursinus College Women West Chester University Women Widener University Women York College Women -select from the list- , Other:
versus Visitors:		Albright College Women Bloomsburg University Women Bryn Mawr-Haverford College Women Bucknell University Women College of New Jersey Women Drexel University Women East Stroudsburg University Women Franklin & Marshall College Women Gettysburg College Women Kutztown University Women Lafayette College Women LaSalle University Women Lebanon Valley College Women Lehigh University Women Lock Haven University Women Millersville University Women Muhlenberg College Women Penn State University Women Princeton University Women Saint Joseph's University Women Shippensburg University Women Susquehanna University Women Swarthmore College Women Temple University Women University of Delaware Women University of Pennsylvania Women University of Scranton Women Ursinus College Women West Chester University Women Widener University Women York College Women -select from the list- , Other:
Who won?		Albright College Women Bloomsburg University Women Bryn Mawr-Haverford College Women Bucknell University Women College of New Jersey Women Drexel University Women East Stroudsburg University Women Franklin & Marshall College Women Gettysburg College Women Kutztown University Women Lafayette College Women LaSalle University Women Lebanon Valley College Women Lehigh University Women Lock Haven University Women Millersville University Women Muhlenberg College Women Penn State University Women Princeton University Women Saint Joseph's University Women Shippensburg University Women Susquehanna University Women Swarthmore College Women Temple University Women University of Delaware Women University of Pennsylvania Women University of Scranton Women Ursinus College Women West Chester University Women Widener University Women York College Women -select from the list- , Other:
		Scoring
		Winning:	Losing:
Final Score:
Trys Scored:
Conversions Scored:
Penalty Goals Scored:
Drop Goals Scored:
Medical Information
Yes or No, Which of the following was available at the match?
Medical Kit:		No Yes -none-
Athletic Trainer:		No Yes -none-
EMT:		No Yes -none-
Was an Emergency Action Plan (EAP) provided to visiting team by home team?		No Yes -none-
Did EAP provide address and directions to nearest hospital?		No Yes -none-
Other Medical Personnel
Describe:
If any players were injured, please provide name and describe injury:
Referee Information
If any players were 'sent off' by the referee, please provide name:
Name of referee:
Comments about referee:
Eligibility Verification
Did your opponents check for School IDs?		No Yes -none-
Protest
Was this match played under protest by your team?		No Yes -none-
		If yes, you must provide protest information in writing, within 48 hours of the match, to the .
All-Stars
Identify players from your's or your opponent's club you think might be candidates for the EPRU All-Star team.
Name:
Position:		Center Fly Half Full Back Hooker Number Eight Prop Scrum Half Second Row Wing Wing Forward -none-
Email Address:
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Name:
Position:		Center Fly Half Full Back Hooker Number Eight Prop Scrum Half Second Row Wing Wing Forward -none-
Email Address:
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Name:
Position:		Center Fly Half Full Back Hooker Number Eight Prop Scrum Half Second Row Wing Wing Forward -none-
Email Address: