Referee Payment Form


Please print clearly. For each game you worked please indicate the date, home and away teams, location and the amount in the appropriate referee or lines box. Indicate the total games worked. Add each column and place the amount in each Total Payment Due column. Add each of the total payment due columns and enter this amount into the last Total Payment Due column. This summary must be turned into the EMSA Mill Woods office by the end of the 3rd week of each month.

Cheques will be made available at the end of the month and can be picked up a the EMSA Mill Woods office.

Payment summary(s) received after the deadline will be processed for the next month’s pay. If you would like your cheque mailed out, please add that request and include the postal code with your address. After August 1st a 25% administrative fee will be applied to payment forms submitted.

Any questions or concerns can be addressed to Ricardo Lodhar at 780-721-5710.