Expense Remibursement Form Your InformationName* First Last Phone*Alt PhoneEmail* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Reimbursement DetailsYou may include multiple receipts if dealing with the same account code. Up to 5 account codes may be attached to this form. If you have more, please complete this form again with the new accounting codes.Merchant* Receipts*Max. file size: 256 MB.Select Account Code:*5999 · Board:6000 · Printing5999 · Board:6010 · Postage5999 · Board:6020 · Phone5999 · Board:6030 · Miscellaneous6099 · Executive committee:6100 · President6099 · Executive committee:6101 · Vice President6099 · Executive committee:6102 · Chairman of the Board6099 · Executive committee:6103 · Treasurer6099 · Executive committee:6104 · Recording secretary6099 · Executive committee:6105 · Corresponding secretary6129 · Awards/Hall of Fame/Scholarship:6120 · Awards committee miscellaneous6129 · Awards/Hall of Fame/Scholarship:6130 · Awards to be awarded6129 · Awards/Hall of Fame/Scholarship:6131 · Awards committee expenses6129 · Awards/Hall of Fame/Scholarship:6132 · Scholarships to be awarded6129 · Awards/Hall of Fame/Scholarship:6133 · Grant to foundation6139 · Ethics committee6140 · Budget and finance committee6141 · Bylaws committee6142 · Certification and education com6143 · Convention committee6147 · Property& record/Historical Com6148 · Historical storage6149 · International committee6150 · Internet/Ways & means committee6151 · Internet development and maint.6153 · New app development6154 · Membership committee6155 · Newsletter/Recap committee6166 · Nominations&elections/Job Descr6169 · Steinman award6230 · Publicity/Logo committee6231 · Publicity-marketing6232 · Publicity/Brochures printing6233 · Publicity/Brochures postage6241 · Rep committee printing6242 · Rep committee postage - US6243 · Rep committee postage- Intl6244 · Rep/Chapters committee misc6252 · Scholarship fund-Susan Jacobson6254 · Scholarship fund-Rena Will6349 · Membership coordinator:6360 · Postage and mail forwarding6349 · Membership coordinator:6365 · Membership printing6349 · Membership coordinator:6380 · Coordinator miscellaneous6349 · Membership coordinator:6385 · Coordinator travel6349 · Membership coordinator:6390 · Coordinator fee6391 · Constant Contact6399 · Financial records manager:6400 · Financial records mailfwd/post.6399 · Financial records manager:6410 · Fin. records electronic storage6399 · Financial records manager:6420 · Fiancial records manager fee6500 · Professional fees:6508 · Professional fees-other6500 · Professional fees:6510 · Financial6500 · Professional fees:6511 · Legal6500 · Professional fees:6512 · Photographer6513 · Mail forwarding6515 · Internet Coordinator Fee6520 · Insurance-ICES,chapters, conven6570 · Bank charges6599 · Newsletter:6600 · Printing6599 · Newsletter:6610 · Periodical postage6599 · Newsletter:6615 · Mailing service6599 · Newsletter:6630 · Editor fee6599 · Newsletter:6640 · Miscellaneous6599 · Newsletter:6651 · Newsletter editor travel6599 · Newsletter:6652 · Editor miscellaneous postage6599 · Newsletter:6653 · Digital newsletter production6654 · Equipment maintenance6655 · Depreciation expense6700 · Reps correspondence expenses6749 · Allotment funds:6710 · Reps Convention Breakfast expense6749 · Allotment funds:6740 · Show Directors Conven Allotment6749 · Allotment funds:6750 · Board convention6749 - Allotment funds: 6765 - Reps Annual Membership allotment6749 · Allotment funds:6760 · Reps midyear6749 · Allotment funds:6765 · Board midyear meal expense6749 · Allotment funds:6770 · Board midyear6749 · Allotment funds:6780 · Show directors midyear6749 · Allotment funds:6800 · Board midyear meal expense6810 · ICES Seed money6830 · Interest6840 · Penalties6850 · Taxes and license (non show)6855 · Taxes and licenses show (ASCAP)6860 · Miscellaneous6900 · Gain/Loss sale of investmentsDescription*Subtotal Amount*Do you have another Merchant Receipt?* No Yes Accounting Code #2 Receipts and InformationVendor #2* Receipts #2*Max. file size: 256 MB.Select Account Code: #2*5999 · Board:6000 · Printing5999 · Board:6010 · Postage5999 · Board:6020 · Phone5999 · Board:6030 · Miscellaneous6099 · Executive committee:6100 · President6099 · Executive committee:6101 · Vice President6099 · Executive committee:6102 · Chairman of the Board6099 · Executive committee:6103 · Treasurer6099 · Executive committee:6104 · Recording secretary6099 · Executive committee:6105 · Corresponding secretary6129 · Awards/Hall of Fame/Scholarship:6120 · Awards committee miscellaneous6129 · Awards/Hall of Fame/Scholarship:6130 · Awards to be awarded6129 · Awards/Hall of Fame/Scholarship:6131 · Awards committee expenses6129 · Awards/Hall of Fame/Scholarship:6132 · Scholarships to be awarded6129 · Awards/Hall of Fame/Scholarship:6133 · Grant to foundation6139 · Ethics committee6140 · Budget and finance committee6141 · Bylaws committee6142 · Certification and education com6143 · Convention committee6147 · Property& record/Historical Com6148 · Historical storage6149 · International committee6150 · Internet/Ways & means committee6151 · Internet development and maint.6153 · New app development6154 · Membership committee6155 · Newsletter/Recap committee6166 · Nominations&elections/Job Descr6169 · Steinman award6230 · Publicity/Logo committee6231 · Publicity-marketing6232 · Publicity/Brochures printing6233 · Publicity/Brochures postage6241 · Rep committee printing6242 · Rep committee postage - US6243 · Rep committee postage- Intl6244 · Rep/Chapters committee misc6252 · Scholarship fund-Susan Jacobson6254 · Scholarship fund-Rena Will6349 · Membership coordinator:6360 · Postage and mail forwarding6349 · Membership coordinator:6365 · Membership printing6349 · Membership coordinator:6380 · Coordinator miscellaneous6349 · Membership coordinator:6385 · Coordinator travel6349 · Membership coordinator:6390 · Coordinator fee6391 · Constant Contact6399 · Financial records manager:6400 · Financial records mailfwd/post.6399 · Financial records manager:6410 · Fin. records electronic storage6399 · Financial records manager:6420 · Fiancial records manager fee6500 · Professional fees:6508 · Professional fees-other6500 · Professional fees:6510 · Financial6500 · Professional fees:6511 · Legal6500 · Professional fees:6512 · Photographer6513 · Mail forwarding6515 · Internet Coordinator Fee6520 · Insurance-ICES,chapters, conven6570 · Bank charges6599 · Newsletter:6600 · Printing6599 · Newsletter:6610 · Periodical postage6599 · Newsletter:6615 · Mailing service6599 · Newsletter:6630 · Editor fee6599 · Newsletter:6640 · Miscellaneous6599 · Newsletter:6651 · Newsletter editor travel6599 · Newsletter:6652 · Editor miscellaneous postage6599 · Newsletter:6653 · Digital newsletter production6654 · Equipment maintenance6655 · Depreciation expense6700 · Reps correspondence expenses6749 · Allotment funds:6710 · Reps Convention Breakfast expense6749 · Allotment funds:6740 · Show Directors Conven Allotment6749 · Allotment funds:6750 · Board convention6749 - Allotment funds: 6765 - Reps Annual Membership allotment6749 · Allotment funds:6760 · Reps midyear6749 · Allotment funds:6765 · Board midyear meal expense6749 · Allotment funds:6770 · Board midyear6749 · Allotment funds:6780 · Show directors midyear6749 · Allotment funds:6800 · Board midyear meal expense6810 · ICES Seed money6830 · Interest6840 · Penalties6850 · Taxes and license (non show)6855 · Taxes and licenses show (ASCAP)6860 · Miscellaneous6900 · Gain/Loss sale of investmentsDescription #2*Subtotal Amount #2Do you have a Third Merchant Receipt to submit?* No Yes Accounting Code #3 Receipts and InformationVendor #3* Receipts #3*Max. file size: 256 MB.Select Account Code: #3*5999 · Board:6000 · Printing5999 · Board:6010 · Postage5999 · Board:6020 · Phone5999 · Board:6030 · Miscellaneous6099 · Executive committee:6100 · President6099 · Executive committee:6101 · Vice President6099 · Executive committee:6102 · Chairman of the Board6099 · Executive committee:6103 · Treasurer6099 · Executive committee:6104 · Recording secretary6099 · Executive committee:6105 · Corresponding secretary6129 · Awards/Hall of Fame/Scholarship:6120 · Awards committee miscellaneous6129 · Awards/Hall of Fame/Scholarship:6130 · Awards to be awarded6129 · Awards/Hall of Fame/Scholarship:6131 · Awards committee expenses6129 · Awards/Hall of Fame/Scholarship:6132 · Scholarships to be awarded6129 · Awards/Hall of Fame/Scholarship:6133 · Grant to foundation6139 · Ethics committee6140 · Budget and finance committee6141 · Bylaws committee6142 · Certification and education com6143 · Convention committee6147 · Property& record/Historical Com6148 · Historical storage6149 · International committee6150 · Internet/Ways & means committee6151 · Internet development and maint.6153 · New app development6154 · Membership committee6155 · Newsletter/Recap committee6166 · Nominations&elections/Job Descr6169 · Steinman award6230 · Publicity/Logo committee6231 · Publicity-marketing6232 · Publicity/Brochures printing6233 · Publicity/Brochures postage6241 · Rep committee printing6242 · Rep committee postage - US6243 · Rep committee postage- Intl6244 · Rep/Chapters committee misc6252 · Scholarship fund-Susan Jacobson6254 · Scholarship fund-Rena Will6349 · Membership coordinator:6360 · Postage and mail forwarding6349 · Membership coordinator:6365 · Membership printing6349 · Membership coordinator:6380 · Coordinator miscellaneous6349 · Membership coordinator:6385 · Coordinator travel6349 · Membership coordinator:6390 · Coordinator fee6391 · Constant Contact6399 · Financial records manager:6400 · Financial records mailfwd/post.6399 · Financial records manager:6410 · Fin. records electronic storage6399 · Financial records manager:6420 · Fiancial records manager fee6500 · Professional fees:6508 · Professional fees-other6500 · Professional fees:6510 · Financial6500 · Professional fees:6511 · Legal6500 · Professional fees:6512 · Photographer6513 · Mail forwarding6515 · Internet Coordinator Fee6520 · Insurance-ICES,chapters, conven6570 · Bank charges6599 · Newsletter:6600 · Printing6599 · Newsletter:6610 · Periodical postage6599 · Newsletter:6615 · Mailing service6599 · Newsletter:6630 · Editor fee6599 · Newsletter:6640 · Miscellaneous6599 · Newsletter:6651 · Newsletter editor travel6599 · Newsletter:6652 · Editor miscellaneous postage6599 · Newsletter:6653 · Digital newsletter production6654 · Equipment maintenance6655 · Depreciation expense6700 · Reps correspondence expenses6749 · Allotment funds:6710 · Reps Convention Breakfast expense6749 · Allotment funds:6740 · Show Directors Conven Allotment6749 · Allotment funds:6750 · Board convention6749 - Allotment funds: 6765 - Reps Annual Membership allotment6749 · Allotment funds:6760 · Reps midyear6749 · Allotment funds:6765 · Board midyear meal expense6749 · Allotment funds:6770 · Board midyear6749 · Allotment funds:6780 · Show directors midyear6749 · Allotment funds:6800 · Board midyear meal expense6810 · ICES Seed money6830 · Interest6840 · Penalties6850 · Taxes and license (non show)6855 · Taxes and licenses show (ASCAP)6860 · Miscellaneous6900 · Gain/Loss sale of investmentsDescription #3*Subtotal Amount #3*Do you have a Fourth Merchant Receipt to submit?* No Yes Accounting Code #4 Receipts and InformationVendor #4* Receipts #4*Max. file size: 256 MB.Select Account Code: #4*5999 · Board:6000 · Printing5999 · Board:6010 · Postage5999 · Board:6020 · Phone5999 · Board:6030 · Miscellaneous6099 · Executive committee:6100 · President6099 · Executive committee:6101 · Vice President6099 · Executive committee:6102 · Chairman of the Board6099 · Executive committee:6103 · Treasurer6099 · Executive committee:6104 · Recording secretary6099 · Executive committee:6105 · Corresponding secretary6129 · Awards/Hall of Fame/Scholarship:6120 · Awards committee miscellaneous6129 · Awards/Hall of Fame/Scholarship:6130 · Awards to be awarded6129 · Awards/Hall of Fame/Scholarship:6131 · Awards committee expenses6129 · Awards/Hall of Fame/Scholarship:6132 · Scholarships to be awarded6129 · Awards/Hall of Fame/Scholarship:6133 · Grant to foundation6139 · Ethics committee6140 · Budget and finance committee6141 · Bylaws committee6142 · Certification and education com6143 · Convention committee6147 · Property& record/Historical Com6148 · Historical storage6149 · International committee6150 · Internet/Ways & means committee6151 · Internet development and maint.6153 · New app development6154 · Membership committee6155 · Newsletter/Recap committee6166 · Nominations&elections/Job Descr6169 · Steinman award6230 · Publicity/Logo committee6231 · Publicity-marketing6232 · Publicity/Brochures printing6233 · Publicity/Brochures postage6241 · Rep committee printing6242 · Rep committee postage - US6243 · Rep committee postage- Intl6244 · Rep/Chapters committee misc6252 · Scholarship fund-Susan Jacobson6254 · Scholarship fund-Rena Will6349 · Membership coordinator:6360 · Postage and mail forwarding6349 · Membership coordinator:6365 · Membership printing6349 · Membership coordinator:6380 · Coordinator miscellaneous6349 · Membership coordinator:6385 · Coordinator travel6349 · Membership coordinator:6390 · Coordinator fee6391 · Constant Contact6399 · Financial records manager:6400 · Financial records mailfwd/post.6399 · Financial records manager:6410 · Fin. records electronic storage6399 · Financial records manager:6420 · Fiancial records manager fee6500 · Professional fees:6508 · Professional fees-other6500 · Professional fees:6510 · Financial6500 · Professional fees:6511 · Legal6500 · Professional fees:6512 · Photographer6513 · Mail forwarding6515 · Internet Coordinator Fee6520 · Insurance-ICES,chapters, conven6570 · Bank charges6599 · Newsletter:6600 · Printing6599 · Newsletter:6610 · Periodical postage6599 · Newsletter:6615 · Mailing service6599 · Newsletter:6630 · Editor fee6599 · Newsletter:6640 · Miscellaneous6599 · Newsletter:6651 · Newsletter editor travel6599 · Newsletter:6652 · Editor miscellaneous postage6599 · Newsletter:6653 · Digital newsletter production6654 · Equipment maintenance6655 · Depreciation expense6700 · Reps correspondence expenses6749 · Allotment funds:6710 · Reps Convention Breakfast expense6749 · Allotment funds:6740 · Show Directors Conven Allotment6749 · Allotment funds:6750 · Board convention6749 - Allotment funds: 6765 - Reps Annual Membership allotment6749 · Allotment funds:6760 · Reps midyear6749 · Allotment funds:6765 · Board midyear meal expense6749 · Allotment funds:6770 · Board midyear6749 · Allotment funds:6780 · Show directors midyear6749 · Allotment funds:6800 · Board midyear meal expense6810 · ICES Seed money6830 · Interest6840 · Penalties6850 · Taxes and license (non show)6855 · Taxes and licenses show (ASCAP)6860 · Miscellaneous6900 · Gain/Loss sale of investmentsDescription #4*Subtotal Amount #4*Do you have a Fifth and Merchant Receipt Code to submit?* No Yes More accounting code ? Just complete this form again upon submitted. Vendor #5* Receipts #5*Max. file size: 256 MB.Select Account Code: #5*5999 · Board:6000 · Printing5999 · Board:6010 · Postage5999 · Board:6020 · Phone5999 · Board:6030 · Miscellaneous6099 · Executive committee:6100 · President6099 · Executive committee:6101 · Vice President6099 · Executive committee:6102 · Chairman of the Board6099 · Executive committee:6103 · Treasurer6099 · Executive committee:6104 · Recording secretary6099 · Executive committee:6105 · Corresponding secretary6129 · Awards/Hall of Fame/Scholarship:6120 · Awards committee miscellaneous6129 · Awards/Hall of Fame/Scholarship:6130 · Awards to be awarded6129 · Awards/Hall of Fame/Scholarship:6131 · Awards committee expenses6129 · Awards/Hall of Fame/Scholarship:6132 · Scholarships to be awarded6129 · Awards/Hall of Fame/Scholarship:6133 · Grant to foundation6139 · Ethics committee6140 · Budget and finance committee6141 · Bylaws committee6142 · Certification and education com6143 · Convention committee6147 · Property& record/Historical Com6148 · Historical storage6149 · International committee6150 · Internet/Ways & means committee6151 · Internet development and maint.6153 · New app development6154 · Membership committee6155 · Newsletter/Recap committee6166 · Nominations&elections/Job Descr6169 · Steinman award6230 · Publicity/Logo committee6231 · Publicity-marketing6232 · Publicity/Brochures printing6233 · Publicity/Brochures postage6241 · Rep committee printing6242 · Rep committee postage - US6243 · Rep committee postage- Intl6244 · Rep/Chapters committee misc6252 · Scholarship fund-Susan Jacobson6254 · Scholarship fund-Rena Will6349 · Membership coordinator:6360 · Postage and mail forwarding6349 · Membership coordinator:6365 · Membership printing6349 · Membership coordinator:6380 · Coordinator miscellaneous6349 · Membership coordinator:6385 · Coordinator travel6349 · Membership coordinator:6390 · Coordinator fee6391 · Constant Contact6399 · Financial records manager:6400 · Financial records mailfwd/post.6399 · Financial records manager:6410 · Fin. records electronic storage6399 · Financial records manager:6420 · Fiancial records manager fee6500 · Professional fees:6508 · Professional fees-other6500 · Professional fees:6510 · Financial6500 · Professional fees:6511 · Legal6500 · Professional fees:6512 · Photographer6513 · Mail forwarding6515 · Internet Coordinator Fee6520 · Insurance-ICES,chapters, conven6570 · Bank charges6599 · Newsletter:6600 · Printing6599 · Newsletter:6610 · Periodical postage6599 · Newsletter:6615 · Mailing service6599 · Newsletter:6630 · Editor fee6599 · Newsletter:6640 · Miscellaneous6599 · Newsletter:6651 · Newsletter editor travel6599 · Newsletter:6652 · Editor miscellaneous postage6599 · Newsletter:6653 · Digital newsletter production6654 · Equipment maintenance6655 · Depreciation expense6700 · Reps correspondence expenses6749 · Allotment funds:6710 · Reps Convention Breakfast expense6749 · Allotment funds:6740 · Show Directors Conven Allotment6749 · Allotment funds:6750 · Board convention6749 - Allotment funds: 6765 - Reps Annual Membership allotment6749 · Allotment funds:6760 · Reps midyear6749 · Allotment funds:6765 · Board midyear meal expense6749 · Allotment funds:6770 · Board midyear6749 · Allotment funds:6780 · Show directors midyear6749 · Allotment funds:6800 · Board midyear meal expense6810 · ICES Seed money6830 · Interest6840 · Penalties6850 · Taxes and license (non show)6855 · Taxes and licenses show (ASCAP)6860 · Miscellaneous6900 · Gain/Loss sale of investmentsDescription #5*Subtotal Amount #5*Total and Submittal informationTOTAL Reimbursement RequestedBy clicking “I agree", I agree to use an electronic signature to demonstrate my acceptance of the above information. I understand and agree that an electronic signature and/or electronic acceptance is as legally binding as an ink signature.I Agree* Digital Signature This form is not complete unless you click “submit" and will be used as your digital signature. Once you have submitted the form you should receive a “Thank You” confirmation email. If you do not receive this “Thank You” email then your form DID NOT go through and you will need to RE-SUBMIT your form. Please double check to make sure you: Have filled in all the required information, (a RED message will appear if information is missing).Este formulario no está completo a menos que haga clic en "enviar".Una vez que haya enviado el formulario, debe recibir un correo electrónico de confirmación de "Gracias". Si no recibe este correo electrónico de "Agradecimiento", entonces su formulario NO se envió y tendrá que REITERAR su formulario.Por favor, vuelva a verificar para asegurarse de que:Ha completado toda la información requerida (aparecerá un mensaje ROJO si falta información).EmailThis field is for validation purposes and should be left unchanged. Δ