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Thrivent Member Network board reimbursement request

Complete this form and submit it along with all supporting receipts for reimbursement. This form should only be completed for expenses incurred by the regional board member. Please indicate the address you would like the reimbursement check sent to.

Those who haven't completed a W9 in the past, please complete a W9 form and mail it into the following address: Thrivent, Attn: Accounts Payable - MS 1320, 600 Portland Avenue S., Suite 100, Minneapolis, MN 55415.

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Board Member Information
Expense Reimbursement Details (to be completed by board member)
Attach up to four files. Note: Max combined file size limit is 10MB.
*Electronic signature (please check box and enter name below electronically – printing the form is not necessary)

Please allow 3-4 weeks for payment from time of submission. If you have any questions please contact