Intramural Sports Refund Request

Refund Request

Original Form of Payment
- Cash/Check
- Credit/Debit Card
Amount Paid
Sport
Division
League
Order Number
Reason for Refund*
Name*
First Last
Phone Number*
Cal Poly Email*
Additional Email
Mailing Address*
Street Address Address Line 2 City State ZIP Code
*
I have read and reviewed the cancellation policies located online. I am aware that there is a deadline to submit request for refund and that there might be a 20% administrative fee assessed.*
Signature*
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