Senior Athlete Reimbursement Form

  • Senior Athlete Reimbursement Form

    Please submit one form per club per meet!

  • Contact Information

    Please provide contact information for the person making the request.

  • Meet Information

  • I agree that all listed athletes have been Ozark Swimming LSC members for at least 1 year or more:*
  • I agree that each listed athlete swam at least one individual or one relay event (no time trials only)*

  • Athlete Info

  • Athlete 1-Participation*
  • Athlete 2-Participation*
  • Athlete 3-Participation*
  • Athlete 4-Participation*
  • Athlete 5-Participation*
  • Athlete 6-Participation*
  • Athlete 7-Participation*
  • Athlete 8-Participation*
  • Athlete 9-Participation*
  • Athlete 10-Participation*
  • Athlete 11-Participation*
  • Athlete 12-Participation*
  • Athlete 13-Participation*
  • Athlete 14-Participation*
  • Athlete 15-Participation*
  • Athlete 16-Participation*
  • Athlete 17-Participation*
  • Athlete 18-Participation*
  • Athlete 19-Participation*
  • Athlete 20-Participation*
  • Athlete 21-Participation*
  • Athlete 22-Participation*
  • Athlete 23-Participation*
  • Athlete 24-Participation*
  • Athlete 25-Participation*
  • Athlete 26-Participation*
  • Athlete 27-Participation*
  • Athlete 28-Participation*
  • Athlete 29-Participation*
  • Athlete 30-Participation*
  • Athlete 31-Participation*
  • Athlete 32-Participation*
  • Athlete 33-Participation*
  • Athlete 34-Participation*
  • Athlete 35-Participation*
  • Athlete 36-Participation*
  • Athlete 37-Participation*
  • Athlete 38-Participation*
  • Athlete 39-Participation*
  • Athlete 40-Participation*

  • Total Due to Club ($)

  • Checks are payable to the club. This submission provides the itemized breakdown by athlete. 

  • 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 Ozark Swimming, Inc.

  • Should be Empty: