Wellness Team

Race Participation Reimbursement Form

As a Quad City based employee, QCR Holdings, Inc. will reimburse you for participation in two local races each year. You qualify for a reimbursement of up to $25 per race, for a maximum refund of $50 per year.

To be reimbursed for your participation, please use the form below. Your payment to the race organizers must be submitted prior to your reimbursement request. Reimbursements are processed monthly, via direct deposit or check.

Please contact the Wellness Team if you have any questions at wellnessteam@qcrh.com.

Reimbursement Form

Employee Name *

Email Address (A confirmation message will be sent to this email address) *

Entity *

Location *

Name of Race *

Attach Receipt (PDF) *

Please attach a PDF receipt of your paid race entry to be reimbursed. (4Mb max)

PDF files only

Captcha *