NC SILC Quarterly Meeting Reimbursement Form

NC SILC QUARTERLY MEETING HONORARIUM REQUEST
Thank you for your attending the NC SILC Quarterly Meeting.

The meeting honorarium for the 2024-25 Fiscal year is $50.00. You must attend at least 50% of the meeting to be elgible for the honorarium. Attendance will be verified based on Roll Call Records.

Please complete this form and submit to the SILC Executive Director within 25 days of the Quarterly SILC Meeting. This form can be submitted electronically or emailed to gloria.garton@nc-silc.org. Verbal authorizations to receive or donate the honorarium are not allowed.
Name*

FIRST NAMELAST NAME
PHONE NUMBER*
Ex: (910) 000- 0000
STREET ADDRESS
CITY
STATE
ZIP CODE
Quarterly SILC Meeting Date:*
Attendance will be verified from Roll Call Records
I am requesting my meeting stipend to be:*

mailed to the address provided aboveelectronically deposited to my bank accountdonated back to the NC SILC
Should be Empty:

NC SILC QUARTERLY MEETING HONORARIUM REQUEST