"*" indicates required fields This form is to be used only for Department Officers/Chairmen/PDP's to be reimbursed for a Department event. This form MUST BE submitted within 30 days of the end of the event. Any submissions after 30 days will result in the denial of reimbursement.Name* First Last Email* Department Officer/Chairman Title*Department Event*Choose only one. Workshop Fall Conference Convention Girls State ABC/Leadership VA&R UD&R Finance Meeting Other ABC Class Location (Unit#)List Add RemoveBeginning Date of Event* MM slash DD slash YYYY Ending Date of Event* MM slash DD slash YYYY Are you requesting reimbursement for hotel stay?* Yes No If yes, upload hotel receipt*FORMS MUST BE UPLOADED AS A PDF. PICTURES, JPEG, OR ANY OTHER FORMAT CAN NOT BE USED. USING ANY FORM OTHER THAN A PDF WILL CAUSE YOUR SUBMISSION TO BE DELAYED AS IT IS NOT CONSIDERED COMPLETE.Accepted file types: pdf, Max. file size: 1 GB.Are you requesting reimbursement for mileage?* Yes No If yes, upload mileage documentation*FORMS MUST BE UPLOADED AS A PDF. PICTURES, JPEG, OR ANY OTHER FORMAT CAN NOT BE USED. USING ANY FORM OTHER THAN A PDF WILL CAUSE YOUR SUBMISSION TO BE DELAYED AS IT IS NOT CONSIDERED COMPLETE.Accepted file types: pdf, Max. file size: 1 GB.Round Trip Miles Traveled*Where you the driver?* Yes No If no, who wasDid you stay in the designated or overflow hotel (where applicable)?* Yes No List all roommatesDid you or your passenger(s) or roommate(s) receive any type of travel reimbursement from ALA, SAL, Legion or any other source* Yes No If yes, what typeFrom whom?How much?Consent*I am requesting reimbursement above based on actual expenses incurred as a Department Officer, Chairman, Committee member, appointee, or call-in to the meeting per current approved budget year guidelines. I certify that all information submitted is true and accurate. I understand failure to include proof of mileage from a map source or hotel receipt with my name listed on the reservation or a request that is submitted AFTER 30 DAYS of the event will result in a denial of reimbursement. I agree that all information provided is correct.Date* MM slash DD slash YYYY
