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National Board of Directors Reimbursement Request

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.

To learn more about the privacy of your information, visit our privacy policy.

* Indicates required field

Board Member Information

* First Name:

* Last Name:

* Email:

Format: email@example.com

* Street Address:

* City:

* State:

* ZIP Code:

* Brief explanation of business reason for expenses/travel; include date and location of meeting:

Expense Reimbursement Details (to be completed by board member)

Mileage

Mileage: (Enter Miles)

Mileage Reimbursement Rate: $0.50 per mile

Reimbursement Amount: $0.00

Mileage Explanation:
Airfare

Airfare Amount: ($)

Airfare Explanation:
Ground Transport

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

Ground Transport Explanation:
Parking

Parking Amount: ($)

Parking Explanation:
Hotel

Hotel Amount: ($)

Hotel Explanation:
Meals

Meals Amount: ($)

Meals Explanation:
Entertainment

Entertainment Amount: ($)

Entertainment Explanation:
Other

Other Amount: ($)

Other Explanation:

Total Reimbursement Amount: $0.00

Attachments
Attach up to four files. Note: Max combined file size limit is 10MB.

Attachment 1:

Attachment 2:

Attachment 3:

Attachment 4:

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:

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

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