Professional Development Support Reimbursement Request

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I. RECIPIENT INFORMATION


PERSON ATTENDING THE CONFERENCE






Recipient Mailing Information



Two letter abbreviation.




Recipient Demographic Survey






II. Conference/Workshop Information




III. Itemized Expenses

$
Maximum: $175

$

$

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CERTIFICATION
By virtue of checking the box below and clicking the "Submit" button, I certify that all information contained in this Request for Reimbursement is true. 


Questions or concerns regarding this reimbursement form or process?
Contact: Christine Bial
(816) 421-1388, ext. #227
Christine@maaa.org

The reimbursement recipient must retain all records regarding the conference/workshop as well as the documentation submitted with this request for three years.