Wellness Team

Race Participation Reimbursement Form

As a Quad City based or M2 Lease Funds employee, QCR Holdings, Inc. will reimburse you if you participate in two local races each year. You qualify for a refund 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 application and payment to the race organizers must be submitted prior to your reimbursement request.

If you are participating on a QCBT, QCRH or m2 team, please pay for the race in full and follow the instructions for payment from your team captain. Then, complete this form to be reimbursed for your participation. Your team captain is not responsible for submitting your reimbursement request.

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 *