2025 Move United Individual Membership Receipt Submission Form (FORM 2 of 2)

Move United /

Congratulations! You were selected as a Move United Individual Membership Grant recipient. We are so excited for you!

Grant funding will be distributed to you by mail upon providing a receipt for purchases – receipts can be submitted via the form below.
Further instructions and deadlines can be found in your award notification email.

If you have questions regarding your submission, please contact Dr. Brittany Derecha, Member Services Manager – Individuals at bderecha@moveunitedsport.org.

2025 Move United Individual Membership Receipt Submission Form

Athlete Name(Required)

First Name Last Name

Do you need to add a parent/guardian/caregiver's name?(Required)

Parent/Guardian/Caregiver Name(Required)

First Name Last Name

Email(Required)

Name of Award(Required)

Who should the reimbursement check be made out to?(Required)

Please explain who the check should be made out to.

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

This is where your reimbursement check will be sent.

Receipt Upload(Required)

Drop files here or

Max. file size: 64 MB.

Please attach all receipts for reimbursement. Receipts must be itemized. Where applicable, if you used your personal vehicle, please upload a map showing the mileage driven.

Photos/Videos Upload

Drop files here or

Max. file size: 64 MB.

If you'd like to provide photos or videos attending the event or using the equipment, we'd love to feature some of our grant recipients on our social accounts.

Is there any additional information you'd like us to know?