ASAP Reimbursement Form
Speaker Name
Email
*
example@example.com
Name of Event
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
# of Kits Sold
Speaking Fee
# of Kits Sold and Speaking Fee
Kits Sold: 0 - Speaking Fee: $550
Kits Sold: 1 - Speaking Fee: $700
Kits Sold: 2 - Speaking Fee: $850
Kits Sold: 3 - Speaking Fee: $1,000
Kits Sold: 4 - Speaking Fee: $1,550
Kits Sold: 5 - Speaking Fee: $1,800
Kits Sold: 6 - Speaking Fee: $2,350
Kits Sold: 7 - Speaking Fee: $2,650
Kits Sold: 8 - Speaking Fee: $2,950
Kits Sold: 9 - Speaking Fee: $3,250
Kits Sold: 10 - Speaking Fee: $3,550
Kits Sold: 11 - Speaking Fee: $3,850
Kits Sold: 12 - Speaking Fee: $4,150
Kits Sold: 13 - Speaking Fee: $4,450
Kits Sold: 14 - Speaking Fee: $4,750
Kits Sold: 15 - Speaking Fee: $5,050
Kits Sold: 16 - Speaking Fee: $5,350
Kits Sold: 17 - Speaking Fee: $5,650
Kits Sold: 18 - Speaking Fee: $5,950
Kits Sold: 19 - Speaking Fee: $6,250
Kits Sold: 20 - Speaking Fee: $6,550
Kits Sold: 21 - Speaking Fee: $6,850
Kits Sold: 22 - Speaking Fee: $7,150
Kits Sold: 23 - Speaking Fee: $7,450
Kits Sold: 24 - Speaking Fee: $7,750
Kits Sold: 25 - Speaking Fee: $8,050
Kits Sold: 26 - Speaking Fee: $8,350
Kits Sold: 27 - Speaking Fee: $8,650
Kits Sold: 28 - Speaking Fee: $8,950
Kits Sold: 29 - Speaking Fee: $9,250
Kits Sold: 30 - Speaking Fee: $9,550
Kits Sold: 31 - Speaking Fee: $9,850
Kits Sold: 32 - Speaking Fee: $10,150
Kits Sold: 33 - Speaking Fee: $10,450
Kits Sold: 34 - Speaking Fee: $10,750
Expenses
Meals
Plane Ticket
Baggage Fee
Hotel Room
Hotel Parking
Car Rental / Taxi
Airport Parking
Gratuities
Miscellaneous
Total Expenses
Receipts from Event
Upload Receipts
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of
Comments for Event
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