Application for Waiver of Registration Fees 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 PhoneEmail 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 neededDateEnding date of waiver: Date Format: MM slash DD slash YYYY DateStarting 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) Δ