LL - Form C - LWVUS PMP Approval and Withdrawal Request Grant Request

LL - Form C - LWVUS PMP Withdrawal Request
Partial Payment for LWVUS PMP Obligations of Your Local League

Reminder: LWVUS allows the local League to pay up to 50% of the PMP assessment with Education Fund money. This form must be submitted to and approved by the LWVWA Education Fund prior to submitting your PMP payment to LWVUS.

When this completed form is received by the LWVWA Education Fund a check to "LWVUS Education Fund" will be mailed to you. Then it can be sent with your share of the PMP payment to the National League.
Date*

MonthDayYear
Date
Name of League*
Contact person for local League
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
Local League Treasurer
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Amount requested
Total Amount of PMP payment to be submitted to LWVUS*
Amount requested from your Education Fund Account*
Send check to:
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Request Approval
President has approved this request
Name of Local League President*

First NameLast Name
Email*
Should be Empty:

LL - Form C - LWVUS PMP Withdrawal Request