{"id":112,"date":"2022-06-08T10:56:20","date_gmt":"2022-06-08T16:56:20","guid":{"rendered":"https:\/\/new2.rocv.org\/?page_id=112"},"modified":"2023-07-31T12:56:05","modified_gmt":"2023-07-31T18:56:05","slug":"reimbursement","status":"publish","type":"page","link":"https:\/\/rocv.org\/reimbursement\/","title":{"rendered":"Reimbursement Request"},"content":{"rendered":"\n<p>Use this form to request a reimbursement check. Checks are issued on Fridays. Email the ROCV Treasurer, <a href=\"mailto:treasurer@rocv.org\">Dan Retzlaff<\/a>, with questions.<\/p>\n\n\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_4_container\" data-token=\"c320b15baa6c85f13da0b9d88c60775e\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_pro_form \" id=\"form_reimbursement\" data-token=\"c320b15baa6c85f13da0b9d88c60775e\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Reimbursement<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"reimbursement\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"6d167dab1d\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/api\/wp\/v2\/pages\/112\" \/><div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <div  id=\"field_z5php_label\" class=\"frm_primary_label\">Your Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_z5php_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tYour Name\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_21\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_21-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_z5php_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_z5php_first\" value=\"\" name=\"item_meta[21][first]\" autocomplete=\"given-name\" data-reqmsg=\"Your Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_21_first_desc\">First<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_21-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_z5php_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_z5php_last\" value=\"\" name=\"item_meta[21][last]\" autocomplete=\"family-name\" data-reqmsg=\"Your Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_21_last_desc\">Last<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm6\">\r\n    <label for=\"field_hnak1\" id=\"field_hnak1_label\" class=\"frm_primary_label\">Your Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_hnak1\" name=\"item_meta[22]\" value=\"\"  data-reqmsg=\"Your Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_s6dhl\" id=\"field_s6dhl_label\" class=\"frm_primary_label\">Reimbursement Amount\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_boxes  frm_with_pre frm_with_post\" style=\"width:10em\"><span class=\"frm_inline_box\">$<\/span><input  type=\"text\" id=\"field_s6dhl\" name=\"item_meta[23]\" value=\"\"  style=\"width:10em\" data-reqmsg=\"Reimbursement Amount cannot be blank.\" aria-required=\"true\" data-invmsg=\"Amount is invalid\" aria-invalid=\"false\" pattern=\"[0-9,]+(.[0-9]{2})?$\"   \/><span class=\"frm_inline_box\">USD<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_sxqm0\" id=\"field_sxqm0_label\" class=\"frm_primary_label\">Check Payee\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_sxqm0\" name=\"item_meta[24]\" value=\"\"  data-reqmsg=\"Check Payee cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <div  id=\"field_zgads_label\" class=\"frm_primary_label\">Check Delivery\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_zgads_label\" role=\"group\">\t\t<select name=\"item_meta[25]\" id=\"field_zgads\"  data-reqmsg=\"Check Delivery cannot be blank.\" aria-required=\"true\" data-invmsg=\"Check Delivery is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"Crest View Office (STAFF ONLY)\">Crest View Office (STAFF ONLY)<\/option><option  value=\"USPS to Another Address\">USPS to Another Address<\/option>\t<\/select>\n\t<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <div  id=\"field_z6d9m_label\" class=\"frm_primary_label\">Check Mailing Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_z6d9m_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tCheck Mailing Address<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_26-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_z6d9m_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tCheck Mailing Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_z6d9m_line1\" value=\"\" name=\"item_meta[26][line1]\"  data-reqmsg=\"Check Mailing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Check Mailing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_26-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_z6d9m_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tCheck Mailing Address\t<\/label>\n\t\t<input type=\"text\" id=\"field_z6d9m_line2\" value=\"\" name=\"item_meta[26][line2]\"  data-reqmsg=\"Check Mailing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Check Mailing Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_26-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_z6d9m_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_z6d9m_city\" value=\"\" name=\"item_meta[26][city]\"  data-reqmsg=\"Check Mailing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Check Mailing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_26-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_z6d9m_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t\t<select name=\"item_meta[26][state]\" id=\"field_z6d9m_state\"  data-reqmsg=\"Check Mailing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Check Mailing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\">\n\t\t\t<option value=\"\" class=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Alabama\">Alabama<\/option><option  value=\"Alaska\">Alaska<\/option><option  value=\"Arkansas\">Arkansas<\/option><option  value=\"Arizona\">Arizona<\/option><option  value=\"California\">California<\/option><option  value=\"Colorado\">Colorado<\/option><option  value=\"Connecticut\">Connecticut<\/option><option  value=\"Delaware\">Delaware<\/option><option  value=\"District of Columbia\">District of Columbia<\/option><option  value=\"Florida\">Florida<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Hawaii\">Hawaii<\/option><option  value=\"Idaho\">Idaho<\/option><option  value=\"Illinois\">Illinois<\/option><option  value=\"Indiana\">Indiana<\/option><option  value=\"Iowa\">Iowa<\/option><option  value=\"Kansas\">Kansas<\/option><option  value=\"Kentucky\">Kentucky<\/option><option  value=\"Louisiana\">Louisiana<\/option><option  value=\"Maine\">Maine<\/option><option  value=\"Maryland\">Maryland<\/option><option  value=\"Massachusetts\">Massachusetts<\/option><option  value=\"Michigan\">Michigan<\/option><option  value=\"Minnesota\">Minnesota<\/option><option  value=\"Mississippi\">Mississippi<\/option><option  value=\"Missouri\">Missouri<\/option><option  value=\"Montana\">Montana<\/option><option  value=\"Nebraska\">Nebraska<\/option><option  value=\"Nevada\">Nevada<\/option><option  value=\"New Hampshire\">New Hampshire<\/option><option  value=\"New Jersey\">New Jersey<\/option><option  value=\"New Mexico\">New Mexico<\/option><option  value=\"New York\">New York<\/option><option  value=\"North Carolina\">North Carolina<\/option><option  value=\"North Dakota\">North Dakota<\/option><option  value=\"Ohio\">Ohio<\/option><option  value=\"Oklahoma\">Oklahoma<\/option><option  value=\"Oregon\">Oregon<\/option><option  value=\"Pennsylvania\">Pennsylvania<\/option><option  value=\"Rhode Island\">Rhode Island<\/option><option  value=\"South Carolina\">South Carolina<\/option><option  value=\"South Dakota\">South Dakota<\/option><option  value=\"Tennessee\">Tennessee<\/option><option  value=\"Texas\">Texas<\/option><option  value=\"Utah\">Utah<\/option><option  value=\"Vermont\">Vermont<\/option><option  value=\"Virginia\">Virginia<\/option><option  value=\"Washington\">Washington<\/option><option  value=\"West Virginia\">West Virginia<\/option><option  value=\"Wisconsin\">Wisconsin<\/option><option  value=\"Wyoming\">Wyoming<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_26-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_z6d9m_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_z6d9m_zip\" value=\"\" name=\"item_meta[26][zip]\"  data-reqmsg=\"Check Mailing Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Check Mailing Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_n4kvv\" id=\"field_n4kvv_label\" class=\"frm_primary_label\">Description of Expense\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <textarea data-auto-grow=\"1\"  name=\"item_meta[27]\" id=\"field_n4kvv\" rows=\"7\"  data-reqmsg=\"Description of Expense cannot be blank.\" aria-required=\"true\" data-invmsg=\"Description of Expense is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_1a5e2\" id=\"field_1a5e2_label\" class=\"frm_primary_label\">Do you have a receipt?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[54]\" id=\"field_1a5e2\"  data-frmval=\"Yes, I have a receipt!\" data-reqmsg=\"Do you have a receipt? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Do you have a receipt? is invalid\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Yes, I have a receipt!\" selected='selected'>Yes, I have a receipt!<\/option><option  value=\"Sorry, I do not have a receipt.\">Sorry, I do not have a receipt.<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm4 frm6 frm12\">\r\n    <label for=\"field_muvz1\" id=\"field_muvz1_label\" class=\"frm_primary_label\">Upload Your Receipts. Screenshot works!\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-reqmsg=\"Upload Your Receipts. Screenshot works! cannot be blank.\" data-invmsg=\"File Upload is invalid\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[28][]\"  data-reqmsg=\"Upload Your Receipts. Screenshot works! cannot be blank.\"  value=\"\" data-frmfile=\"28\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file28_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file28[]\" id=\"field_muvz1\"\n\t\t\t data-frmfile=\"28\" multiple=\"multiple\"  data-reqmsg=\"Upload Your Receipts. Screenshot works! cannot be blank.\" data-invmsg=\"File Upload is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Upload Your Receipts. Screenshot works!. Drop a file here or click to upload. Maximum file size: 64MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Upload Your Receipts. Screenshot works!. Choose File. Maximum file size: 64MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 64MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_55_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm4 frm4 frm12\">\r\n    <label for=\"field_blvki\" id=\"field_blvki_label\" class=\"frm_primary_label\">Why don&#8217;t you have a receipt?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_blvki\" name=\"item_meta[55]\" value=\"\"  placeholder=\"My dog ate it.\" data-reqmsg=\"Why don&#039;t you have a receipt? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_124_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit Request<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_125_container\">\n\t\t\t<label for=\"field_iipeo\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_iipeo\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[125]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"lQsVCfBO\/VOimwHXX\/6gu4r3F2k6+yGmMP9ZWv2sb2D3\/y18cJnF8ZylQfPYWlAF\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Use this form to request a reimbursement check. Checks are issued on Fridays. Email the ROCV Treasurer, Dan Retzlaff, with questions.<\/p>\n","protected":false},"author":5,"featured_media":865,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"wp-custom-template-committee","meta":{"footnotes":""},"class_list":["post-112","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/rocv.org\/api\/wp\/v2\/pages\/112","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rocv.org\/api\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rocv.org\/api\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rocv.org\/api\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/rocv.org\/api\/wp\/v2\/comments?post=112"}],"version-history":[{"count":7,"href":"https:\/\/rocv.org\/api\/wp\/v2\/pages\/112\/revisions"}],"predecessor-version":[{"id":2051,"href":"https:\/\/rocv.org\/api\/wp\/v2\/pages\/112\/revisions\/2051"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/rocv.org\/api\/wp\/v2\/media\/865"}],"wp:attachment":[{"href":"https:\/\/rocv.org\/api\/wp\/v2\/media?parent=112"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}