Expense Reimbursement Form

Personal Information

First Name

Last Name

Email Address

Staff Type

Address Line 1

Address Line 2

City

State

Zip code

Event Information

What season is this for?

What Festival event is this for?

Name of Affiliate Festival Event

What Camp event is this for?

Name of Affiliate Camp Event

What BOA event is this for?

Event Name

What do you need to be reimbursed?

MileageBaggageGround Transportation (Uber, Lyft, shuttle etc.)Select all that apply.

Mileage

Departure/Return City and State

Total Miles Traveled:

Mileage Reimbursement Total (Total Miles x $.760) Code 7512

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.

Adjusted Mileage Amount

Do you need to be reimbursed for any additional tolls or fees?

YesNo

Toll/Fee Amount

Toll/Fee Receipt Upload

Baggage

Cost of Baggage Code 7513

Baggage Receipt Upload

I acknowledge that amount entered for baggage reimbursement exceeds the allowed maximum of $90 per trip.

I accept the maximum baggage reimbursement of up to $90.00 for my trip.

Adjusted Baggage Amount

Ground Transportation

What service was used?

Lyft, Uber, etc.

Cost of Trip

Ground Transportation Receipt Upload

Summary

Grand Reimbursement Total

Notes:

Contact Information