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 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 Meetings Attended Date of Expense * Purpose: * Add 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 upload 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 $ Add 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
