Symposium Speaker Travel Reimbursement

Please use the form linked below to submit your travel reimbursement request. Once completed, the information will be reviewed by ASCB staff, and reimbursement will be processed through Bill.com. Make sure all required documents are included so there are no delays. If you have questions about what to upload or what qualifies for reimbursement, feel free to reach out to us.

Cell Bio 2025 Symposium Speaker Travel Stipend Request Form

The ASCB will provide a travel stipend in the amount listed in your email. To receive it, you will need to do the following:

1. Complete the form below.
2. Set up your account in Bill.com. You’ll receive an email from Bill.com with instructions.
3. Attend the meeting and stay in a hotel within the ASCB housing block, unless you are local, to receive the bonus amount.

Please indicate below whether you plan to accept the travel stipend. If we do not receive this form by December 18, and you have not completed the Bill.com setup, we will not be able to issue the stipend.
General/Contact Information
Name (First/Given and Last/Family)*
Please be sure to list your first name and then your last name.
Please select the title of your Symposium Session*
I am would like to collect the travel stipend.
- YES
- NO
By selecting "YES", I certify that the travel stipend that I am collecting is for eligible travel expenses (meals, airfare, train fare, ground transportation) and that the travel stipend is not being used for expenses that are being paid for or reimbursed by another entity.
Check Payable To (if different than name above; i.e. Institute)
Mailing Address for Check*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email Address of Person Being Reimbursed*
Email Address of Administrative Assistant (if applicable)
Date of Travel to Philadelphia, PA*
MM slash DD slash YYYY
Date of Travel from Philadelphia, PA*
MM slash DD slash YYYY
Upload Your W-9 Form (U.S.-Based Only)
Max. file size: 256 MB.

Please download the W-9 form here, fill it out, and upload it.
Electronic Signature and Agreement to Privacy Policy
I certify that the travel stipend is being used to pay for expenses that were incurred by me, and that are not being reimbursed by another entity.*
- By checking this box, I certify that the travel stipend is being used to pay for expenses that were incurred by me, and that are not being reimbursed by another entity.
Privacy Policy*
- By checking this box, I have read, understand, and agree to the ASCB's Privacy Policy.
Click here to view the ASCB Privacy Policy.
Electronic Signature

In accordance with federal law, the party executing this Agreement electronically - binding the party to the same degree as a handwritten signature - by using the following process to create an electronic symbol signifying intent to be legally bound. The signor must fill in the name, institute, and date below, and check the checkbox at the end of the line marked “Electronic Signature."
The signor shall retain a paper copy of the electronic mail.
Approved and Authorized by:
Print Full Name for Signature*
Signed Date*
MM slash DD slash YYYY
*
- Electronic Signature (Check the Box)

Symposium Speaker Travel Reimbursement

Cell Bio 2025 Symposium Speaker Travel Stipend Request Form

General/Contact Information

Electronic Signature and Agreement to Privacy Policy

Electronic Signature