SMSNA RIG Expense Reimbursement Request
SMSNA will financially support RIG activities and events, up to a certain amount per RIG per year (depending on size, requirements, etc - up to $2,000 per RIG). Prior approval of the activity/event with expenses overview is required to receive reimbursement of expenses. Eligible expenses are Audio Visual equipment/support, Food & Beverages and/or Room Rental. Receipts are required for reimbursement.
RIG Name
*
Please Select
Albany, NY
Atlanta, GA
Chicago, IL
Cleveland, OH
Detroit, MI
Gainesville, FL
Houston, TX
Irvine, CA
Miami, FL
New Haven, CT
New York, NY
Phoenix, AZ
Winnipeg, MB
Submitter Name:
*
First Name
Last Name
Designation:
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(MD, DO, PhD, etc.)
Email:
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example@example.com
Activity/event overview and description of expenses:
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Please fill out, sign, and upload a completed W-9 so payment can be issued. Form should be filled out with the demographics of the individual of whom is to be reimbursed.
Please upload itemized receipt(s) and completed W-9 (above)
*
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Cancel
of
Address to remit payment (if different of that reflected on completed W-9):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*
I understand that submission of this form does not guarantee reimbursement. I also understand prior approval of the activity/event with expenses overview is required to receive reimbursement of expenses.
Submitter signature
*
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