National Board of Directors 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

*First Name

*Last Name

*Email

*Street Address

*City

*State

*ZIP code

*Brief explanation of business reason for expenses/travel; include date and location of meeting0/150

Expense Reimbursement Details (to be completed by board member)

Miles

Mileage Reimbursement Rate: $0.76 per mile

Mileage Reimbursement Amount

Mileage Explanation

Airfare Amount: ($)

Airfare explanation

Ground Transport (Uber, cab, car rental) Amount: ($)

Ground Transport Explanation

Parking Amount: ($)

Parking Explanation

Hotel Amount: ($)

Hotel Explanation

Meals Amount: ($)

Meals Explanation

Entertainment Amount: ($)

Entertainment Explanation

Other Amount: ($)

Other Explanation

Total Reimbursement Amount: ($)

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*Electronic Signature (please check box and enter name below electronically – printing the form is not necessary)

By checking this box, I certify I am submitting accurate and transparent expenses for legitimate business purpose(s) with proper documentation (itemized receipts, attendees).

*Board Member Name

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