Online Assembly Voucher Form Assembly Expense Voucher In order to be eligible for Travel Expense reimbursement, your name must appear on the assembly sign-in sheets. Name & Meeting Attended First Name * Last Name * Date of Meeting Contact Information Email * Mailing Address * Mailing Address Mailing Address Mailing Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Travel Expenses Total No. miles traveled Miles x 0.25 $ No. Additional Passengers No. miles with passengers Passengers x Miles x 0.03 $ Contribution Please deduct from the total travel expense the following sum, which I am hereby making as a contribution to the Presbytery of Ohio Valley. (The amount of your contribution will be included on your year-end giving statement.) Amount of Contribution $ Reimbursement If you are donating any of your expenses, add the amount in the "Contribution" field above. Total Travel Expense $ Less My Contribution - $ Total Reimbursement $ reCAPTCHA Submit If you are human, leave this field blank.