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Forms -- Section Expense Reimbursement Request

_____________________________________
(Name of section, subsection or committee)

REQUESTING PARTY:

    Name: _______________________________________________________

    Address: _____________________________________________________

REIMBURSABLE EXPENSES:

Date Incurred Item Amount
___________ ______________________________ $ ______________
___________ ______________________________ $ ______________
___________ ______________________________ $ ______________
Total Expense:    $ ______________

LINE ITEMS TO BE CHARGED:

MEAL EXPENSES $ ____________________
PRINTING EXPENSE $ ____________________
POSTAGE / LABEL EXPENSE $ ____________________
OTHER EXPENSES $ ____________________

PURPOSE: _______________________________________________________________

Attach All Receipts. Receipts Required For Total Expenses of $75 or more.

____________________________________
Signature of Requesting Party
_____________________________
Date

APPROVAL BY SECTION/COMMITTEE CHAIRPERSON AND SECTION LIAISON:

____________________________________
Signature of Chairperson
_____________________________
Date

____________________________________
Signature of Section/Subsection/Committee Liaison
_____________________________
Date