IMMUNIZATION STATUS FMG2021 REIMBURSEMENT/CREDIT FORM

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IMPORTANT: The deadline to complete a refund request for FMG2021 is midnight Eastern Time on August 22nd, 2021. Tickets will be scanned at the door during the FMG; only unused tickets can be refunded or credited according to your preference. Requests for refunds or credits will be processed after the FMG and no later than November 30, 2021. A form must be completed for each invoice.

Name of buyer: *

E-mail used at time of purchase: *

Invoice number: *

Here is where your invoice number can be found:

TICKET TYPE: In this section, you must indicate for which show you purchased tickets, the zone chosen and the number of tickets to be refunded.

Show #1: *

Quantity of tickets to be refunded for show #1: *

Zone chosen for show #1: *

Show #2:

Quantity of tickets to be refunded for show #2:

Zone chosen for show #2:

Show #3:

Quantity of tickets to be refunded for show #3:

Zone chosen for show #3:

Total value of amount claimed (calculate the amount including taxes): *

Choose one of these options: *

Because I support the FMG and believe in its mission, I would like the amount requested to be transferred to me in the form of a credit for the 2022 edition of the FMG.

I would like the amount requested to be reimbursed directly to my credit card, before the end of 2021.

Declaration *

I hereby confirm that this request for reimbursement or credit is strictly related to my inability, or that of one or more of my guests, to participate in the FMG, because one or more of us will not be fully protected against Covid-19 during the 2021 FMG.

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