Use this form to contact John Puglisi, Region II Representative. This form is for the use of referees who must notify the NISOA Regional Representative regarding an ejection for fighting. We strongly suggest you retain a copy of this report for further use. You will receive a copy of your report via email.

As a minimum, your report must include the following information:

• Date of the game.
• Ejected player's name and team.
• Ejected player's coach's name.
• Home Team.
• Visiting Team.
• A brief description of the incident (i.e. when was the player ejected, were multiple players ejected at the same time, was the match terminated, etc.)