WAUKESHA KENNEL CLUB CHECK OR FUNDING REQUEST FORM IN ORDER TO BE REIMBURSED FOR AN AUTHORIZED CLUB EXPENSE, FILL IN THE FOLLOWING FORM, If you have questions please contact treasurer@waukeshakennelclub.com CHECK TO BE MADE OUT TO:* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail CHECK AMOUNT #*REASON FOR CHECK*Post ImageTAKE A PHOTO OF YOUR RECEIPT AND UPLOAD FROM YOUR DEVICE BY CLICKING the "Choose File" BUTTON BELOW.. BE SURE THAT YOUR IMAGE IS EASY TO READ IN THE PHOTO AND THEN CLICK ON SUBMIT. YOUR REQUEST WITH A COPY OF YOUR RECEIPT IMAGE WILL BE EMAILED TO THE TREASURER. YOU MUST BRING THE ORIGINAL RECEIPT WITH YOU TO THE NEXT GENERAL MEETING AND GIVE TO THE TREASURER BEFORE IT CAN BE SUBMITTED TO THE BOARD FOR PAYMENT APPROVAL.Section BreakRECEIPTS ATTACHED(choose one)NO (will mail or bring to next general meeting)YESADDITIONAL COMMENTSSignature