RIG Activity Funding Request (Pre-Approval)
Please complete this form to propose an expense for approval. Be as detailed as possible to ensure timely review and processing. Please note that this form must be submitted before any expenses are incurred.
RIG Name
*
Please Select
Albany, NY
Bethesda, MD
Birmingham, AL
Boston, MA
Burlington, VT
Central Virginia-Charlottesville/Richmond
Chicago, IL
Cleveland, OH
Cleveland Clinic, OH
Columbus, OH
Dallas, TX
Detroit, MI
Gainesville, FL
Houston, TX
Indiana
Iowa City, IA
Irvine, CA
Los Angeles, CA
Madison, WI
Mexico City, Mexico
Minneapolis, MN
Monterrey, Nuevo Leon-Mexico
Montreal, QC
Nashville, TN
New England
New Haven, CT
New Orleans, LA
New York, NY
Newark, NJ
Northern California
Ottawa, ON
Philadelphia, PA
Phoenix, AZ
Pittsburgh, PA
Portland, OR
Rochester, MN
Rochester, NY
Salt Lake City, UT
San Antonio, TX
St. Louis, MO
Vancouver, BC
Winnipeg, MB
Requester Information
Name:
*
First Name
Last Name
Credentials
Email:
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Expense Details
Expense Title
*
Detailed Description of How Funds Will Be Spent:
*
Expected Benefit/Outcome:
*
Estimated Total Cost:
*
Itemized Breakdown of Expenses
Rows
Item
Description
Quantity
Unit Price
Total
1
2
3
4
Date Expense Will Occur
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submitter signature
*
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Submit
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