Registration Fee Waiver

LIM359 wants to make sure that registration fees do not pose a barrier for any individual with limb loss/difference who wants to participate in our activities. If you feel that your financial circumstances might qualify you for a registration fee waiver, please complete this form and submit it to
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please note that time period may not to exceed 1 year, but applicant may reapply each year or multiple times within the year as needed
Date
Ending date of waiver:
Date Format: MM slash DD slash YYYY
Date
Starting date of waiver:
Date Format: MM slash DD slash YYYY
I believe I qualify for a waiver of registration fees for the following reason(s) (please check all that apply):
- My household income is at or below 150% of the Federal Poverty Guidelines. See the income table.
- I receive a Section 8 housing voucher or live in federally subsidized public housing or am homeless.
- I do not qualify for the above reasons, but I have a financial hardship. Please describe your particular situation below:
*
- I certify that the above information is accurate and take full responsibility for the accuracy of the information provided. (Required)

Living In Motion 359 Days A Year... because you get 6 days to be a couch potato!