2023-2024 MESI OUTREACH MEET FEE REIMBURSEMENT REQUEST

2023-2024 MESI OUTREACH MEET FEE REIMBURSEMENT REQUEST
1. Maine Swimming, Inc. swimmers registered as Outreach Swimmers are eligible to receive swim meet entry fee assistance in the form of a reimbursement from Maine Swimming. Reimbursement checks will be made payable to the club and mailed to the appropriate club contact.

Swimmers may request entry fee reimbursement as follows:
- Full swimmer participation fee
- Full reimbursement for individual meet events in which they competed
- Relays are not reimbursed
- Forms must be submitted within 30 days of the last day of the meet in which participated
Name of Outreach Swimmer*

First NameLast Name
Club Name*
Meet Attended and Dates*
Number of events*
Participation Fee*
Total Amount Requesting*
Club Address to mail the payment*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Coach Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Coach E-mail*
Any notes or additional comments
Signature*

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