Reimbursement Request Form for SMAC-LA approved events

Name *
Name
Address for check to be sent *
Address for check to be sent
Phone *
Phone
Please specify the item for the reimbursement followed by the amount. If you have more than one item, please list them here. For instance: cupcakes $75.00 certificates: $190.00
Has the event been approved by the SMAC-LA board? *

To receive your reimbursement, please email the paper receipt to our bookkeeper, Christine. We will need all receipts for tax purposes, and a refund is not possible without this step. She can be emailed at christine@leonardich.com after you have filled out this form.