WHITECOURT MINOR HOCKEY CLAIM FORM
Note: Expenses will be reimbursed by cheque in approximately 30 days from receipt of this form Questions? email: treasurer@whitecourtminorhockey.com
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Note: WMH will reimburse all fees for coaching requirements (coaching clinics and safety) from Hockey Alberta and will pay a max honorarium of $150 (to cover travel, accommodation, meals) for coaches who are unable to attend coaching clinics in Whitecourt.
Reason and Date of Expense
*
MEALS
Number of Meals
Total $
Breakfast $10.00
Lunch $12.00
Dinner $16.00
ACCOMMODATION
Description
Total $
1
2
3
4
TRAVEL
Destination
Number of KM
($0.70 per KM)- Total $
.
MISCELLANEOUS
Description
Total $
1
2
3
4
TOTAL REIMBURSEMENT SUBMITTED
*
RECEIPTS ARE REQUIRED
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
Submit
Should be Empty: