Officials Reimbursement Pre-Authorization Form

Officials Reimbursement Pre-Authorization Form
Max allowed $700.

Please submit at least four (4) weeks in advance of the event.
Name

First Name Last Name
Date

Month Day Year
Date
Email
example@example.com
Event Name
REASON FOR REIMBURSEMENT: (give a brief description of the event that you plan to attend, such as Zones, Sectional, Arena Pro Swim Series, Futures, Juniors, Nationals or other USA Swimming sponsored National meets and what your position will be at the meet or a recognized workshop.)
Number of Sessions (anticipated to work):
Anticipated Expenses
Travel/Transportation:
Hotel:
Meals:
Other:
Estimated Total:
Should be Empty:

Anticipated Expenses