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Summary: Request
for
Travel
Reimbursement
Name:
E-mail
address:
PTAO
if
known,
or
source
of
funds
(ie
research
funds,
department
travel,
etc.)
Are
all
receipts
included?
If
not,
why.
This
form
must
be
submitted
within
30
days
no
matter
what
the
source
of
funds.
Is
this
form
being
submitted
within
30
days?
If
not,
why.
Dates
of
Travel:
Times
of
Travel:
Start
Return
Name
and
Location
of
Conference:
Purpose
of
Trip
(ie
present
paper,
participate
in
round
table,
etc):
US
Dollars
Only!!
(exchange
rate:
$___________________)
Registration
Fee:
$
Taxis
or
Metro
(circle
one):
$
Airfare/Bus/Train
(circle
one):
$
Personal
Vehicle
Expense:
Mileage:
or
Rental
Charge:
$
Parking:
$
Tolls:
$
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