ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBH
1
2
3
Name
4
5
Address
6
7
8
Travel Expense
9
Appointment pursuing
10
Reimbursement Form
11
Trial at
12
 One form per event 20232026Test session/ Competition/Event
13
14
Please Enter the First Day of Travel1st Day2nd Day3rd Day4th Day5th Day6th Day7th DayPeriod Totals
15
16
Personal Auto Mileage Rate:
0.725 - - - - - - -
17
Rental/Auto
18
Air Fare
19
Rail Fare
20
Taxi Fare
21
Bus Fare
22
Parking Fees
23
Tolls
24
Tips
25
Lodging (Incl. Tax)
26
Breakfast (Incl. Tax/Tip)
27
Lunch (Incl. Tax/Tip)
28
Dinner (Incl. Tax/Tip)
29
Telephone
30
Copy Expenses
31
Other Expenses (please detail)
32
Daily Totals
33
34
I hereby certify that all expenses claimed above were incurred training for USFSA trial juding and accounting appointments.
35
36
37
Signature:
Date:
38
39
Signature:
Date:
40
Test Chair/Competition Chair
41
Approved:
Date:
42
Neicc Challenge Cup Oversight Committee
43
44
45
46
Reimburse by:
47
Return Reimburment form and receipts to:
48
 Julie Harte
Check
49
9 Hillsdale Rd
50
Randolph, MA 02368 TOTAL from Above
51
Juliehharte@gmail.com
52
Deadline for receipts of forms Due from NEICC
53
 by the January 31st
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100