Network Science Meets Neuroscience Reimbursement Form

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.

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*
MM slash DD slash YYYY
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	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.

Network Science Meets Neuroscience Reimbursement Form

Basic Information

Attendee Requesting Reimbursement Information

Who is filling out this request?

Expense Information