2023 Series Champion - Reimbursement Request Form

USA Archery Arizona is pleased to support the winners of the 2023 AZ Series Championship with up to $190 reimbursement toward a national tournament during the 2024 calendar year.

Eligibility requirements are listed below. Please make sure to read through each item prior to submitting your request.

Athlete must have been awarded 1st place at the conclusion of the 2023 AZ Series Points program. 2023 Series Championship results can be found HERE.
Athlete must register and compete in a national level event during the 2024 calendar year.
Submit your regsitration information below and email the receipt to the following email address: usaarcheryaztreasurer@gmail.com.
Reimbursement is limited to a maximum of $190 per athlete.
Reimbursement check will be issued after completion of national competition has been verified.

Athlete's Name*

First NameLast Name

E-mail Address*

Phone Number*

Area CodePhone Number

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

USA Archery Membership #*

National Tournament *

Please list the tournament that you have registered for and will be competing in that you are requesting reimbursement towards.

Date of Tournament*

For multi-day events, please enter the last day of competition.

What was the registration fee amount paid for the tournament.*

The amount should match the receipt submitted.

Photo Release: Applicant grants USAA-AZ permission to use the applicant’s likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration. Applicant understands and agrees that these materials will become the property of USAA-AZ and will not be returned. Applicant grants USAA-AZ the authority to edit, alter, copy, publish or distribute this photo for purpose of publicizing USAA-AZ programs or for any other lawful purpose. In addition, the applicant waives the right to inspect or approve the finished product, including written or electronic copy, wherein the likeness may appear.

Official Recognition: By electronically signing below and submitting the request, applicant certifies that any information or documentation submitted in support of this application are accurate and truthful. Applicant recognizes and certifies that he/she/they has/have read and understand the above Photo Release.

Electronic Signature of athlete or parent/guardian if under the age of 18. *

First NameLast Name

If minor, name of parent/guardian for which check will be issued

First NameLast Name

By clicking the submit below button you acknowledge and agree to all of the terms listed above.

2023 Series Champion Winners