CENTRAL NEW YORK UMPIRES BAT FORM

DATE _____ /_____ / _____ LOCATION _______________________

FIELD _________ TIME: __________

BAT: MAKE ________________________ MODEL __________________________

PASSED / FAILED SERIAL NUMBER ____________________________ ( If Bat Fails)

OWNER: NAME ____________________________ TEAM NAME __________________________

ADDRESS _________________________________

CITY ____________________________ STATE ____________ ZIP ______________

CONTACT # _____ - __________

UMPIRE REQUESTED: UMPIRE _________________________________

OPOSITION REQUESTED: NAME ________________________________ ( Individual Paying Fee)

CONTACT # _____ - ____________

I, _______________________ the undersigned have agreed to submit my bat for compression testing under USSSA guidelines. I further understand that if my bat passes today, it may be tested again in the future. In addition I understand that if my bat fails, and I am found using the bat that I will be immediately suspended from all sanctioned USSSA play for a period of two (2) years.

Signed: _________________________ Date: _____ /______ /_______

Acknowledgement of return of bat

OWNER Signed:___________________ Date: _____ /______ /_______

USSSA REP Signed:___________________ Date: _____ /______ /_______