Event or Activity: _______________________________________________________________________ Date of Event or Activity: ________________________________________________________________
Please note that a Request for Reimbursement form needs to be completed for each person who incurred expenses and requests reimbursement. The Chair for each event will need to collect and submit all Request for Reimbursement forms with their Event Summary of Expenses form.
Expenses Incurred: Please provide an itemized listing of expenses incurred and sign below. Attach receipt(s) to this form and send to the LND/SMC Treasurer. A check will be mailed to the name and address listed above.