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Est. 1994
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    EPRU PRU
    VRU USAR

    		  

    Mid- Atlantic Rugby Football Union Disciplinary Report
    Confidential
    [This report will be sent to the MARFU, EPRU, PRU, and VRU Disciplinary Chairs.]

    Player
    Information
    Player's First name (required):
    Player's Last name (required):

    CIPP Number (required):
    [If you do not have the player's USA CIPP number, go to the USA Rugby Club Roster site and look for the player's number under his/her club; be sure to look at the second page of the roster. If the player is not listed under the club, please note this in the comments and enter 99999 for the number.]
    Position of Player:
    Player's Team (required):
    Match Level (A, B, C, other):
    Location of match:
    Date of Incident:
    / / 2010

    Card
    Information
    Red Card
    Red card (resulting from two Yellow Cards)
    Yellow Card
    Administrative Offense
    (Used for a non-cardable offense which warrants a disciplinary report;
    examples of this may include sideline behavior, abuse of a referee by a team official, etc.)
    Offense for which penalized under Law or Administrative guidelines?
    Were other yellow or red cards issued to other players during the incident in which this player received a yellow or red card?
    Yes
    No

    Match
    Information
    Opponent Team:
    Player's team score at the time of the incident:
    Opponent's score at the time of the incident:
    Elapsed game time in the match (MM:SS):
    1st Half?
    2nd Half?
    Player's team final score:
    Opponent's final score:


    Narrative
    Information

     

    Please provide full details on the incident.

    Items to consider:

    Were previous warnings issued?

    Did anything provoke the incident?

    Were there any relevant incidents after issuing the card?

    Referee
    or
    Administrator
    Information
    Reporter's name (required):
    First:
    Last:
    Your referee society (if referee) or union association (if administrator):
    Your Email address (required):
    Your phone number:
    Your role in the match, if you were not the referee (touch judge, other; elaborate as necessary; if you were not the referee, please provide the referee's name):
    Were (referee) Touch Judges present? If so, please list their names and referee societies: