Entry Fee Request

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="044fd5a3.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>HUNTER MOUNTAIN RACING FOUNDATION</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="HUNTER MOUNTAIN RACING FOUNDATION"><U><B>home</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Mission Statement"><U>Mission Statement</U></A>   |   <A HREF="id42.htm" TARGET="_top" TITLE="Grant Information"><U>Grant Information</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Grant Application"><U>Grant Application</U></A>   |   <B>Entry Fee Request</B>   |   <A HREF="id18.htm" TARGET="_top" TITLE="Competition Development Programs"><U>Competition & Development Programs</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Events"><U>Events</U></A>   |   <A HREF="id32.htm" TARGET="_top" TITLE="Member Application"><U>Member Application</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Donors Benefactors"><U>Donors & Benefactors</U></A>   |   <A HREF="id33.htm" TARGET="_top" TITLE="Alumni Athletes "><U>Alumni Athletes </U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="News"><U>News</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="Hunter Mountain USSA/USASA Event Registr"><U>Hunter Mountain USSA/USASA Event Registration</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE="Board of Directors"><U>Board of Directors</U></A>   |   <A HREF="id41.htm" TARGET="_top" TITLE="Event Pictures"><U>Event Pictures</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="045d2043.jpg"> <div> <B>Click </B><A HREF="id42.htm" TARGET="_top" TITLE="Grant Information"><U><B>here</B></U></A><B> to see the list of events that qualify for entry fee reimbursement.</B></div> <bR> <div> <B>Entry fee reimbursement does not require Board approval</B></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Entry Fee Request</I></div> <div> The following Entry Fee Request is for athlete reimbursement for entry fees for events <I>beyond local qualifier events</I>.  If you are applying for multiple entry fees, copy this page and use one sheet for each entry.</div> <bR> <div> Complete this form and submit it to the HMRF Treasurer, Scott Berwick either by email <A HREF="mailto: sbewick@huntermtn.com" TARGET="_top" TITLE="mailto: sbewick@huntermtn.com"><U>sberwick@huntermtn.com</U></A>, or Fax the request to 518-263-3704, or by mail to HMRF/ Scott Berwick - PO Box 295 - Hunter, NY 12442.</div> <bR> <bR> <div> Name: ___________________________________________________</div> <bR> <div> Address: _________________________________________________</div> <bR> <div> State: ________    Zip: ____________</div> <bR> <div> Phone: __________________ E-mail: __________________________</div> <bR> <div> Event Title:________________________________________________</div> <div>  </div> <div> Event Date: ____________ Event Site: __________________________</div> <bR> <div> Your Objectives: ____________________________________________</div> <bR> <div> _________________________________________________________</div> <bR> <div> _________________________________________________________</div> <bR> <div> Entry Fee: $_____________________</div> <bR> <div> To the best of my knowledge all the information included in this application is true and correct.</div> <bR> <div> Signature: ________________________________________  Date: _________________</div> <bR> <bR> </td> </tr></table></body>