Honoraria Request Form - UU Ministers Association

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Date Submitted

MM slash DD slash YYYY

Name(Required)

First Last

Email(Required)

Phone

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Type of Volunteer Service (Select One)(Required)

Team or Event(Required)

Select the team, event or project this request is for. This will help us assign the cost appropriately.

Good Offices Specialization Team (Annual)

Peer Coaching (Annual)

Ministerial Formation Network (Event)

Ministry Days (Event)

Webinar Support (Event)

Institute: Presenter (Learning) (Event)

Institute: Presenter (Worship) (Event)

Institute: Support Team (Event)

Collegial Conversation Support (Event)

Other

Would you like to receive an Honorarium for your UUMA Volunteer Work(Required)

Amounts of UUMA Honorarium vary based on the type of work, amount of time involved, and identity of the volunteer. You may elect to receive the full amount, donate the full amount, or donate a portion. You may also decline the honorarium entirely.

Yes, receive the full honorarium

Donate, in part or in full

No thank you, I decline the honorarium

Honorarium

Please list the amount of your honorarium as provided by staff.

Upload Your W-9 Here

If we do not have a W-9 on file for you, please upload it here. (Not needed if donating in full). You may also complete a W-9 form securely on line using this link: https://pdf.ac/233I4J

Max. file size: 2 GB.

Optional Offset Adjustment

We recognize that for some populations of our membership it is more difficult to volunteer. The offset scale has been created to recognize this and to help include those voices in the work of the association. Visit our Honorarium Page (link above) and select one option below.

Please adjust my honorarium based on the offset scale

I do not wish to receive the offset

Offset Amount

Donated Honorarium

If you would like to donate any portion of your honorarium please list the amount here.

How would you like your donation applied

Select the fund you wish to donate to

Total Honorarium due

Event Registration Reimbursement:

This field is specific for those whose volunteer service required registration fees for a UUMA event. If you have paid for registration, do you wish reimbursement (full or partial)

Yes

Registration Amount

Please list the amount you would like to be reimbursed.

Do you have additional costs that require reimbursement?

Cost may include catering for a sponsored Watch Party, Travel for approved GOP work, etc.

Yes

Reimbursement Request

Use the space below to add your a request for reimbursement for any approved expenses. This may include catering for a sponsored Watch Party, Travel for approved GOP work, etc. As you complete the Amount 2 additional lines (up to 5) will appear. If you have more than five expenses you may either combine two on one line or submit an additional form. Total will be calculated using the amount fields.

Details of your first expense

Purpose / Expense code 1

Amount 1

Details of your second expense

Purpose / Expense code 2

Amount 2

Details of your third expense

Purpose / Expense code 3

Amount 3

Details of your fourth expense

Purpose / Expense code 4

Amount 4

Details of your fifth expense

Purpose / Expense code 5

Amount 5

Upload ALL Receipts here

Drop files here or

Max. file size: 2 GB.

Total Reimbursement due

Total Amount to be Paid

Total Donated

Method of Payment(Required)

Select how you would like to receive payment.

Username(Required)

Enter the username for your Paypal or Venmo Account.

ACH Information

This is our preferred payment method: If we do not have an ACH (Auto Clearing House – or direct bank payment), please complete a form at https://pdf.ac/U2i8-uREz

Alternate Address(Required)

If this check should be mailed to a different person/address please give the details here.

Additional notes

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