Authorization for Research-Related Expense Reimbursement Reimbursement Form - Required INSTRUCTIONSAll requests for research related expense reimbursements must be requested in advance via completion and electronic submittal of this form. The abstract acceptance letter and a PDF version of the meeting brochure must also be submitted in advance (please do not e-mail links, etc). RESIDENT INFORMATIONResident Name:* Resident UF ID #:* MEETING INFORMATIONMeeting Name:* Registration Fee*Must pay early/early-bird registration rate. Please plan in advance accordingly. Meeting Date From:* MM slash DD slash YYYY Meeting Date To:* MM slash DD slash YYYY Meeting City:* Meeting State:* Abstract Title:* If more than one abstract has been submitted, please list ALL abstract titles.ACCOMMODATIONSHotel Name:* We recommend staying at the conference hotel. However, the least expensive room option must be selected. If not staying at the conference hotel, your room rate must be comparable to the least expensive rate at the conference hotel. Number of Nights:*The MAXIMUM number of allowable nights will include check-in on the evening before the start of the conference through check-out on the last day of the conference. Alternative requests will be at the discretion of the Associate Chairman for Research. Rate Per Night*AIRFAREAirline:* Economy class only.Flight Cost:*VEHICLE INFORMATIONRental or Personal?* Roundtrip Mileage*REIMBURSEMENTREIMBURSEMENT CONFIRMATION* Original receipts must be submitted to Ken Gaskill (email@example.com) within one week of your return from the conference. Subsequent to your reimbursement, please provide the Office of Research with a copy of your Travel Expense Report. RESEARCH WEEKRESEARCH WEEK CONFIRMATION* By submitting this request, you are agreeing to present your abstract/poster/paper during Research Week. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.