2022-2023 Coach - Trainer Reimbursement (Peterborough Hockey Association)

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Print 2022-2023 Coach - Trainer Reimbursement

Reimbursement or Refund?^*
Refund for clinicReimbursement
If you are requesting a refund for a clinic cancellation please select Refund, if you are a PHA coach or staff who will be on the bench this season please select reimbursement

Information

Person making request^*

Date of birth^*

Open the calendar popup.

Full Address^*

(including postal code)
Phone number^*

Example: ###-###-####
Email Address^*

Example: [email protected]
Course(s) taken/ signed up for^*
Team Assisting^*

Level/Team number or enter n/a if a refund request
Amount Requested^*

$
Receipt(s)^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 3. Maximum File Size: 4MB.
Must be attached

Human Validation

Check The Box ^*