Team BVA Fund Request Form – Blinded Veterans Association

General Instructions

This is the initial step in requesting reimbursement for attending one of the six VA National Clinics. Reimbursement is available exclusively to BVA members, with a maximum of $500 per member per calendar year. Once your request is approved, you will be notified. After attending the event, you must complete the reimbursement form and upload the following documentation: Proof of attendance Receipts for travel or lodging expenses paid by you Please note: The total reimbursement amount cannot exceed $500 per calendar year.

Name

First

Last

BVA Member Number

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Event

Date(s) of Attendance

Please provide the date(s) you plan to attend the event.

Amount Requested? (up to $500)

The BVA reimburses up to $500 per member per calendar year

$500) Phone Date(s)