Entry Fee Request

The following Entry Fee Request is for athlete reimbursement for entry fees for events beyond local qualifier events.  If you are applying for multiple entry fees, copy this page and use one sheet for each entry.

Complete this form and submit it to the HMRF Treasurer, Scott Berwick either by email sberwick@huntermtn.com, or Fax the request to 518-263-3704, or by mail to HMRF/ Scott Berwick - PO Box 295 - Hunter, NY 12442.

Name: ___________________________________________________

Address: _________________________________________________

State: ________    Zip: ____________

Phone: __________________ E-mail: __________________________

Event Title:________________________________________________

Event Date: ____________ Event Site: __________________________

Your Objectives: ____________________________________________

_________________________________________________________

_________________________________________________________

Entry Fee: $_____________________

To the best of my knowledge all the information included in this application is true and correct.

Signature: ________________________________________  Date: _________________