Authorization for Research-Related Expense Reimbursement

Reimbursement Form - Required

  • INSTRUCTIONS

    All requests for research related expense reimbursements must be requested in advance via completion and electronic submittal of this form. The abstract acceptance letter and a PDF version of the meeting brochure must also be submitted in advance (please do not e-mail links, etc).
  • RESIDENT INFORMATION

  • MEETING INFORMATION

  • Must pay early/early-bird registration rate. Please plan in advance accordingly.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • If more than one abstract has been submitted, please list ALL abstract titles.
  • ACCOMMODATIONS

  • We recommend staying at the conference hotel. However, the least expensive room option must be selected. If not staying at the conference hotel, your room rate must be comparable to the least expensive rate at the conference hotel.
  • The MAXIMUM number of allowable nights will include check-in on the evening before the start of the conference through check-out on the last day of the conference. Alternative requests will be at the discretion of the Associate Chairman for Research.
  • AIRFARE

  • Economy class only.
  • VEHICLE INFORMATION

  • REIMBURSEMENT

  • RESEARCH WEEK

  • This field is for validation purposes and should be left unchanged.