OHOP Reimburse Request Event Type(Required) Fortify Your Marriage retreat Reunion Samaritan Lodge Alaska Other Event Description(Required)Did you lead this event as a Key Leader?(Required) Yes No Your Name(Required) First Last Your Email Address(Required) Mailing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Types of Expenses(Required)Please check all that apply. Acceptable receipts must be itemized and include payment information (credit card, cash, etc.). If your receipt is missing the payment information, you may submit a screenshot from your bank account to supplement the missing information. Airport Parking * Checked Baggage Rental Car Fuel Hotel Mileage Meals ** Uber/Ground Transportation * Samaritan’s Purse policy allows reimbursement for parking in the least expensive long-term lot at the airport. If you are requesting reimbursement for a different parking lot, please provide explanation in comments below. ** If you do not have a receipt with itemized details, please include a summary of what was purchased in the comments below.Total Round-Trip Mileage(Required)Receipt Images(Required)Acceptable file types: jpeg, jpg, HEIC, png, pdf Add file... Your file has not been uploaded. Volunteer Log(Required)Acceptable file formats: xls, xlsx Add file... Your file has not been uploaded. Mileage Log(Required)Acceptable file formats: xls, xlsx Add file... Your file has not been uploaded. Additional Notes or CommentsRecaptchaIf you have any questions, please contact us at OHOP@samaritan.org
