Clinic Rebate Form (Durham West Girls Hockey)

Print Clinic Rebate Form
DWGHA CLINIC REBATE FORM- To make sure no volunteer is out of pocket for clinics. Submission Deadlines are: December 1st, 2016 Payment to be received by January 1st, 2017. YOU MUST USE A SEPARATE FORM FOR EACH CLINIC ATTENDED
Personal Details
  1. Example: ###-###-####
I am currently a Member and/ or Support Staff of the following team
  1. RadDatePicker
    Open the calendar popup.
Payment Information
Photos, Word, & PDF Files Accepted.
  1. Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx.
    Maximum # Files: 1. Maximum File Size: 4MB.
    A receipt is MANDATORY for reimbursement.
Human Validation
Printed from on Sunday, March 24, 2019 at 1:41 AM