BOARD MEMBER Expense Report Submission

Expense Report Submission

For Reimbursement
Board Member
Full Name

First NameLast Name
Region #
Office
Governor, Governor-elect, Immediate Past Governor
Email Address
example@example.com
Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Submission Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expense Period - Beginning

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expense Period - Ending

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
TRUSTEE BOARD MEETING / RETREAT

Submit for reimbursement no later than 90 days after event
TRUSTEE BOARD MEETING / RETREAT
Expense Period - Beginning

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expense Period - Ending

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Miles Driven ($0.52/mile)
not to exceed budgeted amount
Mileage Expense
Other Transportation $
per current year policy
Other Transportation - Description
Other Expense $
Other Expense - Description
TOTAL TRUSTEE BOARD MEETING/RETREAT EXPENSE
DCM VISITS

Submit for reimbursement no later than 90 days after event
DCM VISITS
Divisions Visited
Date of Visit - Beginning

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of Visit - Ending

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Miles Driven ($0.52/mile)
more than 100 miles / must be approved in budget
Mileage Expense
Overnight Lodging within Division $
$75/night - must be approved in budget
Other Lodging within Division - Description
TOTAL DCM VISITS EXPENSE
Mid-Year Conference

Submit for reimbursement no later than 90 days after event
MID-YEAR CONFERENCE
Select which Mid-Year Attended
Miles Driven ($0.52/mile)
Mileage Expense
Airfare/Other Transportation $
Hotel $
$75/night
Other Expense $
Other Expense - Description
TOTAL MID-YEAR EXPENSE
International Convention - Hotel

Submit for reimbursement no later than 90 days after event
INTERNATIONAL CONVENTION - HOTEL
Hotel $
$75/Night
Other Expense $
Other Expense - Description
TOTAL INTERNATIONAL CONVENTION HOTEL EXPENSE (Board Member Budget)
International Convention - Travel

Submit for reimbursement no later than 90 days after event
INTERNATIONAL CONVENTION - TRAVEL
Miles Driven (0.52/mile)
Mileage Expense
Airfare/Other Transportation $
Other Expense $
Other Expense - Description
TOTAL INTERNATIONAL CONVENTION TRAVEL EXPENSE (ICON Budget)
not to exceed board approved budget
District Convention

Submission Deadline Date: Sept 30th
DISTRICT CONVENTION
Miles Driven ($0.52/mile)
Mileage Expense
Airfare/Other Transportation $
Hotel $
$75/Night
Other Expense $
Other Expense - Description
TOTAL DISTRICT CONVENTION EXPENSE
Other Expenses

For Governor, Governor-elect and Immediate Past Governor
OTHER EXPENSES
Expense Period: Beginning

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Expense Period: Ending

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event
Miles Driven ($0.52/mile)
Mileage Expense
Airfare/Other Transportation $
Hotel $
$75/Night
Other Expense $
Other Expense - Description
TOTAL OTHER EXPENSES
TOTAL EXPENSE REIMBURSEMENT REQUEST
Please refer to your Board Member Budget

Expense Reimbursement NOT TO EXCEED BUDGET AMOUNTS

Supporting documents must be included for approval and processing
By submitting this form, I certify the expenses are actual.

I have attached supporting receipts, if applicable
Mail Reimbursement To
Make Check Payable To

First NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityStateZip Code
Treasurer Email Address
example@example.com
Finance Email Address
example@example.com
Upload Receipts or Supporting Documents

Cancelof
Should be Empty:

Expense Report Submission

Board Member

TRUSTEE BOARD MEETING / RETREAT

DCM VISITS

Mid-Year Conference

International Convention - Hotel

International Convention - Travel

District Convention

Other Expenses

Mail Reimbursement To