2022-2023 Registration Refund Request (BLOMHA)

Print 2022-2023 Registration Refund Request

Refund Details

Please be as concise as possible.

Please state the reason for this registration refund request^*
YOUR First and Last Name^*

NAME OF PERSON CHEQUE TO BE PAID TO
Street Address^*

ADDRESS WHERE CHEQUE TO BE MAILED
City^*
Postal Code^*
Email Address^*

Example: [email protected] Your submission will be sent to this address.
Telephone Number^*

Example: ###-###-####

Participant Information

All registration refund requests are subject to a $50 administration fee.

I agree to the terms and conditions stated above^*
I understand this is not an immediate reimbursement. I will receive a refund within one to two weeks. If I have not received payment by this time, I will then contact BLOMHA administration.

I agree to the terms and conditions stated above^*
You will be CC'd on an automated email with your submission attached. That is your confirmation the request was submitted successfully.

I understand.^*

Human Validation