Expense Reimbursement Request

Board members, staff, speakers and residents can use this form to request reimbursement for eligible expenses incurred for AOCD conferences, meetings and other official activities.

How it works

Have a receipt ready for every expense (PDF, JPG, PNG or HEIC, up to 10 MB each). A clear phone photo is fine.
Enter your contact information, your role and the event the expenses were for.
Choose how many expenses you are submitting, then fill in the date, category, description and amount for each one and upload its receipt. Your total is calculated automatically.
Check the certification box and click Submit Reimbursement Request.

Your request and receipts go directly to the AOCD office, and you will receive a copy by email. Questions? Contact admin@aocd.info.

X/Twitter

This field is for validation purposes and should be left unchanged.

1. Requester Information

Full Name(Required)

Email Address(Required)

Phone Number(Required)

2. Your Role

Please select the option that best describes you. If "Other," please specify your role.

Role(Required)

3. Event Information

Event Name(Required)

Event Location (City, State)(Required)

Event Start Date(Required)

Event End Date(Required)

4. Expense Details

List each expense you are requesting reimbursement for. Include a description and upload a receipt (PDF, JPG, PNG or HEIC, max 10 MB) for each expense.

How many expenses are you submitting?(Required)

Select the number of receipts. One row will appear for each expense. Need more than 10? Submit a second request.

Expense 1

Expense 1 – Date of Purchase(Required)

Expense 1 – Category(Required)

Expense 1 – Description(Required)

Expense 1 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 1 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 2

Expense 2 – Date of Purchase(Required)

Expense 2 – Category(Required)

Expense 2 – Description(Required)

Expense 2 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 2 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 3

Expense 3 – Date of Purchase(Required)

Expense 3 – Category(Required)

Expense 3 – Description(Required)

Expense 3 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 3 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 4

Expense 4 – Date of Purchase(Required)

Expense 4 – Category(Required)

Expense 4 – Description(Required)

Expense 4 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 4 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 5

Expense 5 – Date of Purchase(Required)

Expense 5 – Category(Required)

Expense 5 – Description(Required)

Expense 5 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 5 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 6

Expense 6 – Date of Purchase(Required)

Expense 6 – Category(Required)

Expense 6 – Description(Required)

Expense 6 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 6 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 7

Expense 7 – Date of Purchase(Required)

Expense 7 – Category(Required)

Expense 7 – Description(Required)

Expense 7 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 7 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 8

Expense 8 – Date of Purchase(Required)

Expense 8 – Category(Required)

Expense 8 – Description(Required)

Expense 8 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 8 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 9

Expense 9 – Date of Purchase(Required)

Expense 9 – Category(Required)

Expense 9 – Description(Required)

Expense 9 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 9 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Expense 10

Expense 10 – Date of Purchase(Required)

Expense 10 – Category(Required)

Expense 10 – Description(Required)

Expense 10 – Amount (USD)(Required)

Please enter a number greater than or equal to 0.01.

Expense 10 – Receipt(Required)

Accepted file types: pdf, jpg, jpeg, png, heic, Max. file size: 10 MB.

Total Reimbursement Requested

Calculated automatically from the amounts above.

5. Additional Information (Optional)

Additional Information

If there is any additional information related to your request, please include it here.

Expense Reimbursement Request

How it works

1. Requester Information

2. Your Role

3. Event Information

4. Expense Details

Expense 1

Expense 2

Expense 3

Expense 4

Expense 5

Expense 6

Expense 7

Expense 8

Expense 9

Expense 10

5. Additional Information (Optional)

6. Certification