Athlete Travel Reimbursement Application

Athlete Travel Reimbursement Application

Application for club reimbursement of travel expenses related to athlete travel for certain level meets.
Contact Information

Please provide contact information for the person making the request.
Club Name*
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Meet Information
Name of the Meet*
Type of Meet*
Full Reimbursement Value
Auto-filled
Location*

Within Niagara LSCOutside Niagara LSC
Meet Date*

MonthDayYear
Date
Athlete List

Athletes (Within LSC) - only those > 50 miles from venue qualify for reimbursement.

	Athlete Name	Athlete's Home Address (Street and Zip)	1/3	2/3	Full	Denied
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Athletes (Outside LSC)

Olympic Trials
Total of all additional days for all athletes (will add $250 per day per athlete)
Total Portions
Total $ Amount
Further Explanation
Please provide any other details that may be helpful in processing your request.
Remittance

Please provide to whom to remit reimbursement.
Make Check Payable to:*
All checks must be made out to a club.
Send Check to:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By signing below, you attest that all information provided in your request is true and accurate. In addition, your request is in accordance with the Bylaws and Policies and Procedures of the Niagara Swimming, Inc.
Signature*

Clear
Name of Signer*

First NameLast Name
Should be Empty:

Contact Information