Committee/Commission Reimbursement Committee/Commission Expense Voucher Committee/Commission Please submit a separate voucher for each committee/commission. Committee/Commission Name * Name and Contact Information First Name * Last Name * Email * Mailing Address * Mailing Address Mailing Address Mailing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Meetings Attended Date of Expense * Purpose: * plus1 Add minus1 Remove Travel Expenses Total No. miles traveled Miles x 0.25 $ No. Additional Passengers No. miles with passengers Passengers x Miles x 0.03 $ Meal(s) and Lodging Expense Please enter the totaled cost of meal and lodging receipts in the following fields, and then upload images of the original receipts. A maximum of 10 files may be uploaded. File types allowed are JPG, PNG, PDF, DOC and DOCX. You may include multiple receipts in a single image/scan. Total Meal Cost $ Total Lodging Cost $ Upload Receipt(s) Drop a file here or click to upload Choose File Maximum file size: 5MB Childcare Expense Up to $10.00/hr for a maximum of 8 hrs. No. of Childcare Hours Childcare Cost/Hour $ Other Expenses (Itemize) Upload receipts using the upload field in the Meals/Lodging above. Details of Expense Amount of Expense $ plus1 Add minus1 Remove Reimbursement If you are donating any of your expenses, add the amount in the "Less My Contribution" field below. Total Travel Expense $ Total Other Expense $ Subtotal $ Less My Contribution -$ Total Reimbursement $ Captcha If you are human, leave this field blank. Submit
