Reimbursement Form

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* 1. Name:

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* 2. Email:

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* 3. Name of expense approver:

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* 4. Expense type:

Travel

Lodging

Conference fees

Gifts

Supplies

Meals

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* 5. Description of expense:

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* 6. Transaction date:

Date

Date

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* 7. Transaction location:

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* 8. Vendor:

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* 9. Total cost:

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* 10. Receipt:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 11. Additional comments: