Meeting Organizers Form for an IUBMB Jubilee Awardee - Bank Form

Meeting Details

Name of IUBMB Jubilee Award Lecturer *

Total Amount *

USD

The total maximal amount is US $3,000.

Meeting Title *

Location *

Number of days Meeting Attended *

Start Date of Meeting *

Year *

Month *

Day *

End Date of Meeting *

Year *

Month *

Day *

Bank Account Details

First Name *

Middle Name

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Email Address *

Phone

Name of Account Holder *As spelled on the bank documents

Bank Name *

Bank Address *

Account Number **IBAN format for non-US banks; *Canadian bank format is branch transit-financial institution-account number

SWIFT / BANK / BIC *

ABA Code / Routing Number (US)

*You will need to provide the full mailing address of the branch where the account is if you do not have any of the codes

Reimbursement

Please convert all expenses into the same currency. Use Oanda for the day payment and attach a copy to your claim.

Total Amount to be Reimbursed *

USD

The IUBMB will provide the award of US $3,000 (total maximal amount) to the meeting organizer in support of the IUBMB Jubilee Award Lecturer's travel, accommodations, and other expenses incurred by the Awardee.

Upload Receipts and Invoices *

* I declare all expenses are incurred for IUBMB purposes. All receipts / invoices are attached.

Name of Organizer(s) *

Signature of Organizer *

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