Expense Reimbursement Form

What do you need reimbursed? Please select which reimbursement type(s) apply to you

MileageBaggageGround Transportation (Uber, Lyft, Shuttle etc.)

Personal Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip code

Email Address

Staff Type

Travel Information

What Season is this for?

What Event is this for?

Name of Affiliate Festival Event

What Event is this for?

Name of Affiliate Camp Event

What Event is this for?

Other: Please list the title of the event

Departure/Return City and State

Total Miles Traveled:

Mileage Range

Mileage Reimbursement Total (Total Miles x $.70) Code 7512

Tolls/Fees (receipts must be scanned and uploaded)

Receipt

I acknowledge that Mileage Reimbursement is up to the equivalent value of a round-trip flight from my home airport and the calculated Mileage Reimbursement Total exceeds this amount.

I accept the maximum mileage reimbursement of up to $500.00 for my trip.

Baggage Information

What Season is this for?

What Event is this for?

Name of Affiliate Festival Event

What Event is this for?

Name of Affiliate Camp Event

What Event is this for?

Other: Please list the title of the event

Cost of Baggage (receipts must be scanned and uploaded): Code 7513

Receipt

Ground Transportation Information

What Season is this for?

What Event is this for?

Name of Affiliate Festival Event

What Event is this for?

Name of Affiliate Camp Event

What Event is this for?

Other: Please list the title of the event

What service was used?

Cost of Trip (receipt must be uploaded):

Receipt

Grand Reimbursement Total

Notes:

Contact Information