Roanoke Valley Pony Club
EXPENSE VOUCHER
REQUESTS FOR REIMBURSEMENT MUST BE ACCOMPANIED BY APPROPRIATE RECEIPTS
NAME_______________________________________ DATE_______________________
( please print)
(CHECK ONE):
o Fundraiser (date/description): ________________________________________________________
o Meeting (date/type): _______________________________________________________________
o Educational Function (date/description): _________________________________________________
o Social Function (date/description): _____________________________________________________
o Other (date/description):____________________________________________________________
1. Copies/Printing $ __________
2. Postage $__________
3. Supplies (describe) ____________________________________________ $__________
4. Officials’ Fees:
Judge(s) ____________________________________________________ $__________
Clinician ___________________________________________________ $ __________
Safety Personnel _____________________________________________ $ __________
Other (describe) _____________________________________________ $__________
5. Facility Fees $ __________
6. Other (describe) ________________________________________________ $ __________
TOTAL $ __________
DC APPROVAL ______________ FOR OFFICE USE ONLY:
Requestor’s Signature _______________________________ Date Received: ______________
SEND CHECK TO: ________________________________ AMT. PAID: $ ______________
_________________________________________________ CHECK #: __________________
_________________________________________________ Date Paid: ___________________