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H.R. 1610
S. 799
H.R. 8701
Contact
Home
Mission
Leadership Directory
ABCA Past Presidents
ABCA History
Related Organizations
Chiropractic Colleges
State Associations
State Licensing Boards
African American Health Professional Organization
Member Center
MEMBER LOGIN
Member Benefits
Membership Categories
Membership Application
Partnerships
WellReceived
Career Resources
About Chiropractic
What is Chiropractic?
Back Pain Facts & Statistics
Frequently Asked Questions
Chiropractic Research
Students
Scholarship Donation
SABCA Chapters
Harvey Lillard Scholarship
HARVEY LILLARD SCHOLARSHIP ENDOWMENT FUND
NCMIC Charitable Referral Program
Chiropractic Education
Events & Education
ABCA Meetings
Photo Gallery
2023 National Convention
2022 National Convention
2021 National Convention
2019 National Convention
2018 National Convention
ABCA Speaker List
Become an ABCA Speaker
Advocacy
H.R. 1610
S. 799
H.R. 8701
Contact
Reimbursement Request Form
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Reimbursement Request Form
Name
(Required)
First
Last
Amount Requested
(Required)
Purpose of Expense
(Required)
Address To Mail Reimbursement To
(Required)
Street Address
Address Line 2
City
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State
ZIP Code
Do you utilize Zelle?
(Required)
Yes
No
Would you prefer for your reimbursement to be distributed via Zelle?
Yes
No
What phone number or e-mail address is affiliated with your Zelle Account?
Supporting Documents
Please upload all back up documents including invoices and/or receipts.
Back Up Document
(Required)
Max. file size: 32 MB.
Receipt or invoice.
Back Up Document
Max. file size: 32 MB.
Receipt or invoice.
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