Download and/or Print via the following link: Flying Pig Health Grant Reimbursement form.docx

Flying Pig Health Grant Reimbursement Form

All information needs to be sent via email, or mail to Mary Beth Donelan. donelanmb@yahoo.com 7430 E Aracoma Dr Cincinnati, Ohio 45237.  If you need help filling out the form, call Mary Beth Donelan 513-708-5376. The committee will approve requests once a month or more, as needed.  Joyce Asher will send out reimbursements via check and keep a spreadsheet of grants awarded. A member is allowed to submit one form per calendar year, Jan-Dec. 

Ideas for the reimbursements include but are not limited to the following: 

Fitbit, WW membership (formerly Weight Watchers), a fitness class, exercise equipment, a registration fee for an event in which you are participating. If there is something you want to try, give it a go.  Maybe you will like it so much you are hooked! 

 Need help trying to navigate your choice? Reach out to Joyce Asher 513-470-8374 or Mary Beth Donelan 513-708-5376 and they will try their best to help you narrow your choices. 

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FLYING PIG HEALTH GRANT

NAME: ____________________________________________________________
EMAIL: ____________________________________________________________
ADDRESS: _______________________________________________________
_________________________________________________________________
Phone: _____________________________________________
HEALTH PRODUCT OR SERVICE REQUESTED: _____________________________

Dollars requested (max amount allowed $225/member): _________________
PLEASE INCLUDE A RECEIPT, NO REIMBURSEMENT WILL BE MADE WITHOUT PROOF OF
PAYMENT.