NAME - Payable to
EXPENSE REPORT
EMAIL ADDRESS
        EMPLOYER    
        LOCATION    
               
REPORT DATE
Date(s) Purpose:        Committee /               Name of Meeting Transportation: Air, Bus, Rail, Car Rental, Gas Automobile Mileage @ .52/km - provide details below Taxi, Tolls, parking, Etc. Hotel / Lodging Daily Incidental ($5 for each overnight stay) MEAL ALLOWANCE Miscellaneous Expenses (provide details)  TOTAL    
Breakfast ($20) Lunch ($20) Dinner ($35)    
   
   
   
   
   
   
   
   
   
  TOTAL    
      
DETAILS of Automobile Mileage
DETAILS of Miscellaneous Expenses
Date Mileage (km’s)  Purpose Amount
Date   Details   Amount
     
   
     
   
     
   
     
   
Expense Summary Amount
Instructions
 Total Due   Mail To: FULL ADDRESS *    
           
           
  Electronic Signature:      
         
I warrant the truthfulness of the information provided in this application.    * FULL address essential for mailing out of expense cheques.    
  I understand that clicking submit constitutes a legal signature.            
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