Travel Expense Reimbursement Form

CARMA Board of Directors Travel Expense Reimbursement Form

Name(Required)

Email(Required)

District/Agency(Required)

Make Check Payable To:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Meeting Attended(Required)

Location of Meeting(Required)

Arrival Date(Required)

Departure Date(Required)

Complete ONLY the fields for which you are requesting reimbursement. Leave all other fields blank. All costs should be reported in US dollars.

Auto Mileage

Price: $0.67

Please provide the total number of miles you would like to submit for reimbursement. Reimbursement is calculated at .655/mile.

Departing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Destination Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Does your mileage request include return travel?

Yes, this was a round trip (travel from Departing Address > Destination > Departing Location)

Parking/Tolls ($)

Telephone ($)

Taxi/Limousine ($)

Meals/Lodging ($)

Starting Location

Destination

Airline

Airfare ($)

Are there any additional expenses you wish to report?(Required)

Yes

All Other Expenses ($)

Please Describe Expenses:

Total Amount Submitted for Reimbursement:

Please note that all reimbursement requests are subject to review and approval.

Please attach copies of all receipts:

Drop files here or

Max. file size: 50 MB.