ATA Local Expense Reimbursement Form
Please fill in the applicable blanks and attach receipts and/or invoices.
Name
First Name
Last Name
E-mail for E-Transfer
Your E-mail Address
Committee:
Committee Chair:
Nature of Business or Activity:
Location of Business or Activity:
Number of Members Involved from this Local:
Travel (Receipts Required):
Rows
Distance/Note
Cost ($)
Driving (km x 70¢)
Air Fare
Other
Accommodation:
Rows
Nights/Note
Cost ($)
Hotel (max $175/night)
Hotel Parking
Private residence ($50/night)
Other
Meals:
Rows
Day(s)/Note
Cost ($)
Breakfast (days x $20 = cost)
Lunch (days x $20 = cost)
Supper (days x $20 = cost)
Other
Daily Non-receipted Expenses:
Rows
Day(s)
Cost($)
Number of 24 hr days x $100 = cost
Other Expenses (Receipts Required):
Rows
Notes
Cost($)
1
2
3
Total Cost
Receipt and Invoices:
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Additional Notes:
Attachments:
I have attached ALL required receipts/invoices as they cannot be added after submission.
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