WSSRA

Washington State School Retirees Association

PO Box 5127 Lacey WA 98509 360-413-5496
First Name   Last Name    Area Code      Phone Number

Street Address      City   State   Zip

Check here if change of address    Yes
Email
example@example.com
Please select your Unit Name and Number
PLEASE SELECT YOUR BUDGET: WSSRA staff will call chair for approval if signature is required to charge to committee budget.

Mileage Reimbursement:

Rows	Date (M/D/Y)	Destination	Travel Details or meeting attended	Round Trip Miles
1
2

Meals & Hotel: (Please enter in Dollar amount)

Rows	Bkfst	Lunch	Dinner	1 night Hotel
1.

Miscellaneous Expenses:

Washington State School Retirees Association