WI OFFICIALS STATE MEET REIMBURSEMENT REQUEST

WI OFFICIALS STATE MEET REIMBURSEMENT REQUEST

For the Assigned Officials Team
INSTRUCTIONS

Please attach a copy of your hotel receipt and IRS form W-9. This request will NOT be processed without both items.

You can use the link above for the Form W-9. This will open another window where you can download/save the form to your computer. Please complete and sign it (digital and e-signatures are ok), then upload to the form.

You can also print out a blank form from the IRS website, complete and sign it, then either scan it back to your computer and upload to this form or hand deliver it to the Finance Manager. If you prefer to snail mail a copy of your W-9, please contact the Finance Manager at the email address below.

Please complete 1 Reimbursement Request per meet.

This form is for the State Meet Assigned Officials Team, only.

Please do not use this form for officials travel reimbursement.

Direct any questions to FinanceManager@wisconsinswimming.org or OfficialsChair@wisconsinswimming.org

State Meet Assigned Officials Team

Stipend and Hotel Reimbursement Request
NAME
ADDRESS
Street address, City, State, Zip
EMAIL
example@example.com
MEET NAME
LOCATION
MEET DATE - Start

MonthDayYear
Date
MEET DATE - End

MonthDayYear
Date
ASSIGNED POSITION
NUMBER OF DAYS OF SERVICE
NAME OF HOTEL
NUMBER OF NIGHTS
DAILY RATE - include taxes & fees (maximum of $150/night)
Do not enter $ symbol
UPLOAD signed W-9 and Hotel Receipt*

Cancelof
WISCONSIN SWIMMING STATE ASSIGNED OFFICIALS REIMBURSEMENT POLICY:
- All LSC assigned officials positions are compensated
- Assigned officials are eligible for a $100 stipend per day of an LSC Short Course or Long Course State Championship Meet, subject to pre-approval by the Officials Committee
- The stipend compensation includes Time Trials
- A Lodging allowance of up to $150/night, if travel to the meet location is 45 minutes or more, including the night before the meet starts.
- The committee can split a position between two individuals at its discretion and based on needs
Signature*

Clear
Date

MonthDayYear
Date
OFFICE USE ONLY
Stipend Amount
Hotel Amount
TOTAL REIMBURSEMENT
Should be Empty: