*** NOTE ***

WLUSA will only reimburse for travel and housing expenses
There is a 3-night maximum for hotel/housing reimbursements
Athletes must submit receipts for all eligible expenses to: info@wheelchairlacrosse.com

Name

First Name

Last Name

Email

Phone Number

(###)

###

####

WLUSA Team

Reimbursement

Total $ Amount Requested

Mailing Address

If approved, your reimbursement check will be mailed here

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Veteran Reimbursement Form