School:____________________
� |
BASEBALL | FIELD HOCKEY | SOCCER | VOLLEYBALL |
BASKETBALL (See 4. below) | GOLF (Team) | SOFTBALL | WATER POLO |
CROSS COUNTRY (Team) | GYMNASTICS (Team) | TENNIS (Team) | (please circle one) |
SCHOOL:__________________________________ | SPORT:________________ Boys____ Girls____ | ||||
1. DATE OF CONTEST: � _______________ |
SITE:_________________________________ | ||||
Auto Round�Trip Mileage___________ | x $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
2. DATE OF CONTEST:� _______________ |
SITE:_________________________________ | ||||
Auto Round�Trip Mileage___________ | �$.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
3. DATE OF CONTEST:� _______________ |
SITE:_________________________________ | ||||
Auto Round�Trip Mileage___________ | x $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
4. DATE OF CONTEST:� _______________ |
SITE:_________________________________ | ||||
Auto Round�Trip Mileage___________ | x $.34 mile | x _______cars = | $__________ | OR | |
Bus Round Trip Mileage ___________ | x $1.36/mile | x ONE bus = | $__________. | ||
TOTAL DUE� |
$__________________ |
The above information is accurate and travel subsidy is hereby requested on behalf of�my school.
______________________________ ���
�������� __________________���
Athletic Director's Signature
������������������������
�������������Date
Please return to CCS within 10 DAYS OF THE SCHOOL'S� LAST PLAY-OFF CONTEST. |
CCS, 1691 Old Bayshore Highway, Suite
200,� San Jose, CA� 95112 �� |
LATE SUBMISSIONS WILL NOT BE HONORED. |
Phone:� 408-441-9505���� Fax:� 408-441-9509 |