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Claim Forms

Please choose from the following options:

Honoraria Claim Forms

Use this form to claim honoraria for work under the Family Practice Renewal Program (FPRP).

Expense Claims

To claim airfare, rental car, mileage, accommodations, meals, and incidentals, use one of the following methods:

  • Expensify, a free service that automates and manages the process through a mobile app and website. If you already have an Expensify account under the NLMA, please use the Expensify website at, or the Expensify app to submit your expenses.

    Note To sign up to Expensify, please e-mail the NLMA at with the e-mail address you want to use. Once you are added to the NLMA Expensify Policy, you will receive a confirmation e-mail with further instructions.

  • Expense Claim Form Use this form to claim expenses that are incurred by meeting attendance or travel on behalf of the FPRP. If claiming expenses for more than one class (e.g., different committees or multiple trips), separate forms must be used.

Direct Deposit Form

Use this form to start, change, or cancel direct deposit.

Family Practice Renewal Committee (Program Steering Committee)

 Use the FPRP Honoraria Claim Form. Select ‘FPRC Version’ under Form/Type.

Assistance  For assistance, please contact Dawn Mason, Administrative Assistant, FPRP at (709) 726-7424, ext. 309 or