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                                         HOME TEAM:  |  
                                        | No | Name | Pos | L. | SoG |  | 
                                    
                                        | Goals |  
                                        | # | Time | G | A1 | A2 | GS |  | 
                                    
                                        | Participation |  
                                        | P1 | P2 | P3 | P4 | P5 | P6 | N1 | N2 | N3 | N4 | N5 | N6 |  | 
                                    
                                        | Penalties |  
                                        | Time | No | Min | Offence | Start | End |  |  
                            | 
                                    
                                        | 
                               Team Manager: 
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                                                 Head Coach: 
                                         | 
                                                           | 
                                                 A. Coach: 
                                         | 
                                                           |  |  
                        
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                   | 
                                         AWAY TEAM:  |  
                                        | No | Name | Pos | L. | SoG |  | 
                                    
                                        | Goals |  
                                        | # | Time | G | A1 | A2 | GS |  | 
                                    
                                        | Participation |  
                                        | P1 | P2 | P3 | P4 | P5 | P6 | N1 | N2 | N3 | N4 | N5 | N6 |  | 
                                    
                                        | Penalties |  
                                        | Time | No | Min | Offence | Start | End |  |  
                            | 
                                    
                                        | 
                               Team Manager: 
                                         | 
                                                 | 
                                                 Head Coach: 
                                         | 
                                                 | 
                                                 A. Coach: 
                                         | 
                                                 |  |  |