Speaker's Reimbursement Form

Speaker's Reimbursement Form
Please Scroll to the Bottom of Form to Submit Application

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of the Speakers Bureau.

Speaker' Name

Title or Topic of Presentation

Host Organization's Name

Adult Attendance

Children Attendance

Zoom Attendance

Honorarium $150.00

I appeared at an ALL DAY event or gave more than one presentation

Additional Honorarium $150.00

I would like to apply for a Travel Grant. I traveled more than 100 miles roundtrip to presentation.

Travel Grant of $100.00

I traveled over 200 miles Roundtrip

Additional Travel Grant $100.00

Add the Dollar Amounts of the Boxes that are Checked to get the Total Reimbursement Amount

IN-KIND MATCH FOR TRIP. Multiply # of hours for travel and preparation by $10.00.

Additional Info

Thank you for submitting your Speaker Reimbursement Form.

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Speaker's Reimbursement Form
Please Scroll to the Bottom of Form to Submit Application

Do you want to receive the latest
news and events from us?