Darien High School Parent Association Check Request

Date_______________________

Your Name_____________________________Phone ____________________________ Email_________________

DHSPA Committee to be Charged____________________________________

Check Payee___________________________________________Check Amount $___________________________

Mailing Address__________________________________________________________________________________

Detailed Description of Expense_____________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Please remember to attach receipts.

Checks will be mailed to the address listed above unless other arrangements have been made with the Treasurer.  Reimbursements cannot be made without receipts unless an arrangement has been made with the Treasurer.

Mail form with receipts to:

Elizabeth Cortright, DHSPA treasurer, 11 Scout Trail, Darien

(or email reemmm@optonline.net)