Outreach Entry Fee Reimbursement

Outreach Entry Fee Reimbursement

***Please complete a separate form for each meet

This form is to be completed by the Club President or Treasurer (or the paremt of an unattached swimmer) within 30 days after the meet concludes.

REIMBURSED	NOT REIMBURSED
AMS Sanctioned Meets	Non-AMS Meets Approved Meets Observed Meets
Individual Events	Relays & Surcharges
Deck Entries @ regular rate	No-Shows & Scratches

Club Name*
Address*
Contact Name*
Position*
Email*
Phone*
Meet Name*
Meet Date*
Meet Host*
Individual Event Entry Fee*
Below, list the outreach swimmer's name, event numbers he/she swam at the meet, and the total reimbursement amount requested for that swimmer.
Total Amt Requested*
Comments
Should be Empty: