Authorization for Research-Related Expense Reimbursement

Reimbursement Form - Required

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INSTRUCTIONS

All 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 INFORMATION

Resident Name:*

Resident UF ID #:*

MEETING INFORMATION

Meeting Name:*

Registration Fee*

Must pay early/early-bird registration rate. Please plan in advance accordingly.

Meeting Date From:*

Meeting Date To:*

Meeting City:*

Meeting State:*

Abstract Title:*

If more than one abstract has been submitted, please list ALL abstract titles.

ACCOMMODATIONS

Hotel 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*

AIRFARE

Airline:*

Economy class only.

Flight Cost:*

VEHICLE INFORMATION

Rental or Personal?*

Roundtrip Mileage*

REIMBURSEMENT

REIMBURSEMENT CONFIRMATION*

Original receipts must be submitted to 1600 SW Archer Rd. Gainesville, FL 32608 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 WEEK

RESEARCH WEEK CONFIRMATION*

By submitting this request, you are agreeing to present your abstract/poster/paper during Research Week.

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