Bill Irwin and Garrett Smith’s Soccer Camps
@ the University of Portland
-Request for Refund-
Campers Name: ________________________________________________
Camp Session (s) and Date (s): _____________________________________
Amount Paid: ________________________________________________
Reason you are requesting a refund:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
___________
Name of person who paid camp fee: ________________________________
Method of payment (check, money order, cash, credit card): ________________
Street Address: ________________________________________________
City, State, Zip: ________________________________________________
Day time phone: ________________________________________________
Email address: ________________________________________________
Signature of person requesting refund: _____________________ Date:_________
In order to request a refund, please return this form, completed in its entirety, by mail, fax or
email to:
WHITNEY STIPETICH
UNIVERSITY OF PORTLAND
5000 N. WILLAMETTE BLVD.
PORTLAND, OR 97210
FAX NO. 503-943-8082
STIPETIC@UP.EDU
FOR CAMP OFFICE USE ONLY
Amount Paid _______________
Non-Refundable Deposit _______________
Total Refund Amount _______________
Online-line payment order number _______________