Expense Reimbursement – MAATA – Mid-America Athletic Trainers' Association

FINANCE: Expense Reimbursement

I’m filling this out for: *

Submitter Information

If you are filling out this form on behalf of another individual please include your information below.

First Name *

Last Name *

Email *

Phone *

Reimbursee Information

Please complete the information for the person receiving the reimbursement.

First Name *

Last Name *

Address *

Address

This is where the check will be mailed

Address

City

State/Province

Zip/Postal

I prefer to be paid via

Check

Paypal

PayPal ID or E-mail

E-mail *

Phone *

Activity Activity

Location *

Role

Indicate what role or committee you represented at the event

Line Items

Please list your expenses by day/date and category. Some receipts may split into more than one category. For travel (airfare, etc.) and lodging, note those expenses on the first and/or last day of the travel dates. CLICK HERE to view the expense categorization.

Date *

Description

Amount *

Add Remove

Misc Line Items

Date

Amount

Explanation

Add Remove

Mileage Cost

Current Rate: $0.565 x miles
Mileage capped at $350

File Upload

Maximum upload size: 10MB

Please include and upload CLEAR images of your receipts.

TOTAL

Comments

By checking this box, I attest that the above listed expenses were for MAATA related business and I am not recieving reimbursement for the above listed expenses from any other entity.

Agree