District President Quarterly Expense Worksheet

This form is to be used only for District President to be reimbursed for their quarterly visits. This form MUST be received 10 days of the due date.

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This form is to be used only for District Presidents to be reimbursed for quarterly visits. This form MUST BE submitted within 10 days of the end of the quarter. Any submissions after 10 days will result in the denial of reimbursement.

Name*
Quarterly Report Due*
Visits*
List Unit visits in the quarter along with the mileage for each trip. MUST BE District President' Business only.) Starting Point is home or Unit# Ending Point is home or Unit # Unit # MUST BE included on the map printout
Date
Starting Point
Ending Point
# of miles
Round Trip (Yes or No)
 

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      Add any notes that are related to your quarterly reimbursement. If you are requesting to use 2nd quarter milage for the 1st quarter, note that here.
      Consent*
      MM slash DD slash YYYY

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