reimbursement_request.xls
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NWACC Reimbursement Request
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Name
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Title
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Institution
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Make check payable to:
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Mailing address to send check:
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Phone number
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Email
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Destination
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Purpose / Event
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Expenses: Please attach receipts
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Airfare
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Hotel
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Ground Transportation
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Car Rental
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GasolineIf driving a rental car
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Car Mileage (@ $0.56/mile)If driving personal vehicle
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ParkingPullman/Moscow Airport
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Tolls
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Other (please specify):
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Total $ -
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Reimbursement Amount Requested $ -
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Date Reimbursement Requested
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Please include all receipts and submit to Molly Thurston at:
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molly@nwacc.org - or -
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NWACC, PO Box 9128 Portland OR 97207
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