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

Flying Pig Health Grant Reimbursement Form

All information needs to be sent via email, or mail to Mary Beth Donelan.
donelanmb@yahoo.com 6520 Bracken Ridge Ave Cincinnati, Ohio 45213. 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 $200/ member) : _________________
PLEASE INCLUDE A RECEIPT, NO REIMBURSEMENT WILL BE MADE WITHOUT PROOF OF
PAYMENT.