RGA Expense Requisition Form

RGA Expense Requisition Form

For Course Facilitation or Judging Expenses
Hello Course Faciliators and Judges! Thank you for the time and expertise that you have provided to our community!

Please complete the section below regarding your personal information and then complete the section that pertains to your expenses (Course Faciliation or Judging Expenses).

Please have all receipts ready to upload onto this form.

***You do not need to submit receipts for mileage or meals, however no other expenses can be reimbursed without receipts.

There is a Notes section at the end of the form where you can let us know about any details such as who to send the funds to etc.
Name

First NameLast Name
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Expenses

Please complete the section/s that relate to your expenses
Course Facilitation
Name of Event/Course
Date of Event/Course

MonthDayYear
Date
Prep Time (Total Hours)
Ex) 4 hours
Prep Time Total Amount
Ex) $125
Instruction Time (Total Hours)
ex) 20 hours
Instruction Time Total Amount
Ex) $350
Additional Expenses
Please list type of expense ex) stationary, facility fees etc.
Additional Expenses Total Amount
Enter total amount of additional expenses. Receipts must be provided for all additional expenses
Receipt Upload

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Mileage
Ex: Edmonton to Calgary: 350 KM
Mileage Total Amount
RGA pays .35/ cents per approved KM
Travel Costs (Plane Fare, car rental, Uber)
Please list type of travel cost
Reciepts for Travel Costs Upload

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Please upload all receipts for travel costs. These expenses will not be reimbursed if receipts are not provided.
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Total Amount for Travel Costs
TOTAL AMOUNT YOU ARE BILLING FOR COURSE FACILIATION:
ex) $500
Please list all meals that you wish to be reimbursed for:
Judging
Name of Event
Dates of Event

MonthDayYear
Date
Location of Event
Current Judging Level
Total Hours Judging at this event
Ex) Friday: 8hrs, Saturday: 12 hours, Sunday: 6 hours
Total Amount for Judging Honorarium
Based on the information below

Level	Less than 4 hours	4-10 hours	10-16 hours
Interclub	$35	$55	$65
Provincial II	$40	$60	$70
Provincial I		$65	$75
National III	$50	$70	$85
National II	$55	$75	$95
National I	$65	$85	$105
Brevet/JR	$75	$100	$125

Flight Information
Ex) Calgary to Vancouver Return
Total Cost of Flight (including baggage etc.)
$495
Flight Receipts

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Upload receipts for the purchase of flights including baggage etc. Please note that no reimbursements can be made without receipts
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Mileage/Taxi/Uber
Ex)Calgary to Edmonton Roudtrip - 600 km OR Uber Home to Airport, Roundtrip
Total Amount for Mileage/Taxi/Uber
Please note that RGA currently reimbursed .35 cents/km
File Upload for Taxi/Uber Receipts

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Please note that no reimbursements can be made without a receipt
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Accomodation Information
Ex) 3 Nights at the Best Western Vancouver
Accomodation Total Amount
Ex) $600
Accomodation Receipts

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Meals
Please list the meals you with to be reimbursed for: Ex) Mon: Breakfast, Tuesday: Dinner, Wednesday: All meals
Total for Meals
Based on the information below

Inside Alberta	Outside Alberta
Full Day: $40	Full Day: $45
Breakfast: $8	Breakfast: 10
Lunch: $11	Lunch: $12
Dinner: $21	Dinner: $23

TOTAL AMOUNT YOU ARE BILLING FOR:
Honorarium + Travel Costs + Accomodation + Meals
Notes:
Let us know if there is anything that we should be aware of in regards to your expenses. Ex) Please send my expenses payemnt to my club at this address: XYZ
Thank you for submitting your information.
Should be Empty:

RGA Expense Requisition Form

Expenses

Course Facilitation

Judging