Postage Reimbursement Form

The OERB will reimburse a teacher or parent for the out-of-pocket expenses associated with mailing in your Well Site Safety contest forms. Postage receipt is required.

Complete the form below.

Name(Required)

First Last

Social Security #(Required)

Email(Required)

Home Address(Required)

Street Address City State ZIP Code

School Name(Required)

Write "home" if you are participating as a parent or homeschool.

Contest Entry Form Information

Please provide information on the forms mailed. If multiple contest entry forms were mailed, use the + sign to add additional lines.

Details on Forms Mailed(Required)

Entry Form Type (e.g. K-2nd)

# of Forms Mailed

Receipt(s) Upload(Required)

Drop files here or

Accepted file types: jpg, pdf, png, Max. file size: 10 GB.

Must include a copy of the postage receipt.

Total Amount Due(Required)

Date

Please allow up to 4 weeks for processing.

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Postage Reimbursement Form

Contest Entry Form Information

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