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REQUEST FORM FOR A REFUND CREDIT Fall Semester, 1995
 
 
 


5151

REQUEST FORM FOR A REFUND CREDIT
Fall Semester, 1995

Date

Name (Print)

Local Address

I object to the Student Activity Fee funding of the following speech activity(ies):

For this reason, I am requesting a refund of $3.50 of my Student Activity Fee payment in the form of a credit to my University account.

Signature