DSDN Reimbursement/Refund
Please use this form to request reimbursement or refund from DSDN. All submissions will be reviewed and payments dispersed within two weeks. Retreat refunds will be refunded to original payment form. All requests should have prior approval before being submitted. Contact melissa@dsdiagnosisnetwork.org for more information or with questions.
Name
*
First Name
Last Name
Contact email
*
example@example.com
Reason for Reimbursement/Refund
*
Administrative Costs - postage, shipping, supplies, etc.
Travel Expenses
Refund for Retreat Registration
Other
Amount requested:
*
$100 refunds will be issued for the retreat. After the following dates, no refunds are given: Dad event- July 1, Mom event- Aug 1. This does not apply to fundraisers who have reached their level.
Upload Receipt(s) here (no receipt needed if for retreat registration)
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Form of reimbursement/refund:
*
PayPal (quickest option)
Check
No payment needed
Address for payment (email for PayPal; mailing address for check)
*
Submit
Should be Empty: