This form should only be used by OC local chapters who have already been APPROVED by the OC office to receive reimbursement.

The form must be completed post-event in order for your chapter to be reimbursed. Please submit this form and then email copies of your receipts AND your registration/attendee list from the event to expenses@obesitynetwork.ca and pearce@obesitynetwork.ca. We highly encourage the chapter to keep a copy of both the receipts and this form before mailing. Please note it can take up to six (6) weeks to process reimbursements.

**Original receipts must be mailed to the OC office at:

Obesity Canada
2-126 Li Ka Shing Centre for Health
University of Alberta
8602-112 Street
Edmonton, AB T6G 2E1

Attn: Expenses

Email address *
Obesity Canada Local Chapter Name *
Your name *
What is your role in the chapter? *
What is your email? *
What was the name of your event? *
What was the date of your event? *
What type of event was this? *
Was there a registration fee for this event? *
If yes, what was the amount of the registration fee?
What was the total amount collected from the registration fees? *
If no fees were collected, please enter "0"
What was the total number of people in attendance at this event? *
How was this event promoted? *
Social media, website, flyers etc.
Did you receive any type of sponsorship for this event (not including OC local chapter grants)? *
If yes, what form of sponsorship did you receive?
Clear selection
If you did receive sponsorship, who were your sponsors?
What was the total cost for the venue? *
If there was no cost, please enter "0."
Were food and beverages served? *
What was the total cost for the food and beverages? *
If there was no cost, please enter "0."
Did you have speakers at this event? *
Was there a fee for the speakers? *
What was the total cost for the speakers? *
If there was no cost, please enter "0."
Please list the speaker names.
Please provide a brief description & evaluation of the event. *
Please include ~100 words description of your event and attach photos so that we can include these in our OC-SNP monthly newsletter. Please also let us know if there are things you would change, and ideas/dates for future events at your chapter.
Please provide a name and mailing address for the cheque. *
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