2025 NiCE Meeting Reimbursements

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Basic Information
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Date of Request*
MM slash DD slash YYYY
The cutoff date for reimbursements is 60 days from the meeting date. Please note that only items with a receipt and description of expense will be reimbursed. Bank statements are not accepted as receipts.

If you have a US account, the Foundation will send payment via ACH deposit or a USD check to the address you provide. For international attendees, you will be asked for your banking information for a wire transfer.
Attendee Information
Name*
First Last
Email*
Which of the following methods would you like to receive payment?*
- ACH Direct Deposit (US only)
- Wire Transfer (required for international attendees)
- Paper Check (bank must accept USD checks)
Attendee Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
We will mail a check, made payable to:*
Expense Information
At least one expense description and amount is required. Please list all transactions as separate. Do not combine taxi or meal transactions. Description/Comments should include what each charge was for (taxi to/from locations, additional persons that were paid for during meals, etc.) **IF THE CHARGE WAS NOT IN USD, please put the foreign currency amount, and write what currency was used in the Description/Comments section for the charge.

Expenses

Date of Transaction	Currency	Amount	Category	Description/Comments	Actions

There are no Expenses.

Additional Info/Comments
Attach copy of ALL receipts*
Drop files here or

Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 4 MB.
Attach additional documents if necessary
Drop files here or

Accepted file types: pdf, doc, docx, png, jpg, jpeg, Max. file size: 4 MB.
Are you filling out this form for someone else?*
- Yes
- No
Who is filling out this request?
(if different from attendee requesting reimbursement)
Name
First Last
Affiliation/Organization
Email

Basic Information