2020-21 Coach/Trainer Rebate Form (Whitby Girls Hockey Association)

Print 2020-21 Coach/Trainer Rebate Form

Personal Information

Please ensure all contact information is current. This information will be used to mail reimbursement cheques.

First Name^*
Last Name^*
Street Address^*
City^*
Postal Code^*
Primary Contact Telephone Number^*

###-###-####
Email Address^*

An email confirming receipt of your submission will be sent to this address.

Team Information

I am currently a member and/or support staff of the following team:

Course Information

Clinic Type you completed^*
Actual Clinic Date^*

Example: October 21 - 22, 2014
Clinic Location^*

Example: Whitby
Cost^*
Method of Payment^*
CashChequeCredit Card
Please attach a copy of your paid receipt for the clinic^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.
Your application will NOT be considered without this information attached.