2019 GWCO Speaker Expense Report.xlsx
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GWCO Speaker Expense Form
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Name:Mailing Address:
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Tax ID/SSN:Purpose: Speaker Presentation
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Per Mile Rate:$0.545Other Funding Source:
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Description of ExpenseNote DetailsQty Total
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Air/Train Fare 14-day discounted economy class ticket required
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Miles (Personal Car Only)IRS rate per mile will be allowed for direct route (limited to Air Fare)# of miles:
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Taxi (s)Excludes Limousine
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Parking & TollsNecessary parking expenses incurred, with valid receipt limited to economy parking rates and days necessary for presenting.
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MiscellaneousPre-approved expenses
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Per Diem/MealsPer Diem & Meals are not reimbursedNot Allowed
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HonorariumAs stated in speaker contract
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Sub-Total:
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Less amount paid by other funding source:
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Total Amount Due:
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Signature: __________________________________________________ Date: ___________________
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Please attach receipts for all listed expenses, sign the form and return to the GWCO office no later than
November 8, 2019:
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Great Westerm Council of Optometry
info@gwco.org ~ Phone: (206) 209-5273
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