LACUNY Roundtable/Committee Reimbursement Request
Please note $50 is the maximum reimbursement for a regular roundtable/committee meeting. Funding for additional special events is subject to approval by LACUNY. Remember to please upload/submit receipts.
Roundtable/Committee Name: *
Chair (Event Organizer) Name & Email: *
Provide Your Mailing Address for the Reimbursement Check:
Event Name *
Event Date *
MM
/
DD
/
YYYY
Brief Description of Event *
Itemized Amount of Reimbursement
Total Amount ($):
Please Attach/Upload Receipts
Submit
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