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MMSA – Manitoba Medical Students' Association
Manitoba Medical Students' Association
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MMSA Reimbursement Form
MMSA Reimbursement Form
MMSA Reimbursement Form
Name of Group/Portfolio/Initiative
*
Date Submitted
*
MM slash DD slash YYYY
Name of Student to be Reimbursed
*
Each individual wishing to be reimbursed must fill out a separate form
First
Last
Email
*
Class (Year)
Event List
*
If an item or event is being partially reimbursed by another funding source, please mention it in the notes column.
Event Name
Event Date
Item Purchased
Total Cost ($)
Amt to Reimburse ($)
Notes
Receipts
*
Upload scanned copies of your receipts here.
Drop files here or
Select files
Max. file size: 2 MB.
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