Expense Reimbursement Request

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.
The Foundation will reimburse travel for lowest cost non-refundable economy class airfare for the attendee’s route. The Foundation pays for up to two checked bags. Air travel containing personal segment and change fees for personal reasons are not reimbursable.
Please note that the Foundation does not reimburse on a per diem basis. Meals will be reimbursed for the day of the event, or during travel to the event. The daily meal limits that are reimbursable (with accompanying receipts) are:
- $30 – breakfast
- $40 – lunch
- $75 – dinner
Taxicab and ride-sharing fares will be reimbursed with a receipt and the tip clearly noted.
Mileage for personal vehicles is reimbursable at the U.S. Internal Revenue Service Rate (currently $0.625/mi for 2022). A map printout is required as distance documentation.
If you have a US account, the Foundation will send a USD check to the address you provide. For international attendees, if your bank does not accept USD checks, you will be asked for your banking information for a wire transfer.

Hidden

Basic Information

Hidden

Date of Request*

Attendee Requesting Reimbursement Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Do you have a bank account that will accept a paper check in US Dollars?*

Yes
No

It is more expensive for us to send a wire transfer, so if you can accept a USD check that is our preference.

We will mail a check, made payable to:*

Since you do not have a bank account that accepts USD checks, we will send your reimbursement via wire transfer. To do so, we will need the following information:

Name on Account*

Name of Bank*

Bank Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number*

Does your bank and bank account have a:*

IBAN Number
SWIFT/BIC Code
Both IBAN and SWIFT/BIC

We need either IBAN or SWIFT/BIC or both in order to process a wire transfer.

IBAN Number*

SWIFT/BIC Code*

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 to Attendee

Affiliation/Organization

Email

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	Amount	Category	Description/Comments	Actions

There are no Expenses.

Total Expenses

Price: $0.00

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.