GREATER GREEN BAY FIGURE SKATING CLUB                                      PERSONAL REIMBURSEMENT REQUEST

DATE: ____________________________ PAYABLE TO: _______________________________________________________________ MAILING ADDRESS: ________________________________________________________                                         ________________________________________________________                                         ________________________________________________________ TELEPHONE NO: ___________________________________________________________      Receipts for reimbursement MUST BE submitted within 30 days of expense! ______________________________________________________________________   $______________ ______________________________________________________________________   $______________ ______________________________________________________________________   $______________ ______________________________________________________________________   $______________                                                                                                                            TOTAL MONIES DUE  $______________ Signature required as follows: _____________________________/_____________________________/____________________________ Committee Leader                                   Board Member                                          Executive Board Member ($0--$50.00)                                              ($50.01--$250.00)                                    ($250.01 and Up)                                                                   Please attach receipts                   Place in an envelope and drop in the Club lobby mailbox, or mail to:                   GGBFSC Attn:  Treasurer, P.O. Box 28164, Green Bay, WI 54324-0164