REGIONAL FUNDING REIMBURSEMENT This request must be provided to the National Office within ten (10) days of the event. Please submit to: Rho Chi Society National Office, UNC Eshelman School of Pharmacy, CB#7569, 3210 Kerr Hall, 311 Pharmacy Lane, Chapel Hill, NC 27599-7569 Date of Event Name of Event Number of Attendees Organizing Chapter University/College Region Contact Person Contact Title Contact Telephone Contact Email Attendees* Chapter Name University/College Narrative summary of the focus/accomplishments of the meeting List of actual expenses** Submitted by Sponsoring Chapter Advisor Chapter Advisor Name Signature *Send an additional sheet of attendees if necessary. **A list of actual expenses must accompany this request. Please attach receipts.