Gathering Reimbursement

Reimbursement Form

* Indicates required field

Name *

First

Last

Street Address Where check is to be mailed *

State *

Email *

City *

Zip Code *

Comment or Other Information *

Article for the Shepherd's Call, Please submit a description of your gathering for the newsletter editor

Newsletter Article *

Max file size: 20MB

I had pre-approval for my gathering and am a member in good standing of the ESC *

Yes No

Please upload your receipts below. A maximum of $200 will be reimbursed for Gathering Expenses.

First Reciept *

Max file size: 20MB

Third Receipt *

Max file size: 20MB

Second Reciept *

Max file size: 20MB

Fourth Receipt *

Max file size: 20MB

Request for reimbursement above $200 for an Educational speaker. This is a request that will be sent to the board for approval.

Speaker's Name *

Speaker's Topic *

Description of Speaker's topic *

Expected Reimbursement Amount *

Invoice from Speaker *

Max file size: 20MB

If approved, check should be sent to *

Address listed above Speaker Directly

If the Speaker directly is selected, please provide the address where the check should be sent:

Check made out to? *

Street Address *

State *

City *

Zip *

Submit