Outreach Support

Outreach Suit and Meet Fee Support
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 Fee and Suit Cost Reimbursement
Athlete Name

First NameLast Name
Suit Purchased (if seeking competition suit support)

Female Suit ($30)Male Suit ($20)Not seeking reimbursement at this time.
Suit Reimbursement

Meet Information

Total Submitted
Previously Received Suit/Meet Fee Support
Enter the amount that this athlete has previously received this fiscal year under this program.
Eligible Amount
Total to be Reimbursed
Maximum of $100 each fiscal year.
Further Explanation
Please provide any other details that may be helpful in processing your request or that is requested by the approver.
Remittance

Please provide to whom to remit reimbursement
Make Check Payable to: *
Club Name
Send Check to:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check here if this is a change of address.

Yes, this is a new address.
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 Niagara Swimming, Inc.
Signature*

Clear
Name of Signer*

First NameLast Name
Should be Empty:

Outreach Suit and Meet Fee Support