Assembly Reimbursement Request

For use by Intergroups to be reimbursed for expenses associated with sending its Region Representatives to the Region 7 Assembly

Instructions: Complete and submit this form for reimbursement; fields with * are required. Please upload scans or photos of all applicable receipts near the bottom, or email them to the treasurer. Please include a copy of the email from Region 7 indicating that funding was approved, or forward it to the treasurer.
Reimbursement requests without receipts will not be honored.

Your Name:*

Your Email:*

Asssembly Dates:*

Upload a scan or photo of your receipts:Please combine multiple receipts into one document if possible, or up to two additional files. Alternatively, you can email your receipts to the Region 7 Treasurer separately.

Amount*

Amount:

If "Other" expense category chosen, please explain:

MileageFrom p. 6 of Policy Manual Section 2, Article II.B.2. – Miscellaneous Funding for Events (10/13)
2. Driving costs to Region 7 events will be reimbursed as follows but are not to exceed the cost of the cheapest airfare to the destination:
a. Personal vehicle costs are reimbursed at the current volunteer rate allowed by the U.S. Internal Revenue Service, plus parking fees and tolls; OR
b. Personal vehicle costs are reimbursed at actual gas expense, as documented by receipts, plus parking fees and tolls; OR
c. Costs of car rental (including rental fees), actual gas expenses, parking fees and tolls.
If you drive your own (or a friend’s) vehicle and want to be reimbursed for actual gas expenses, fill the tank before leaving. When you get home, fill it again and submit that second receipt for reimbursement.

Number of Miles:

Amount: Miles x $0.14 (IRS Volunteer Rate)

OR Actual Fuel Costs (whichever is less):

Amount:

AND Tolls and Parking:

Amount:

TOTAL REIMBURSEMENT REQUEST:

Amount:

Your Intergroup Treasurer's Email:*

Any special instructions for the Region 7 Treasurer?

Submit Reimbursement Request