NAEOP Travel Reimbursement 1Demographic Information2Travel Details3Total Reimbursement & Electronic Signature Traveler's information:Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*If different than above, payment should be made out to:Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Travel Details and Expenses:NAEOP Board meeting reimbursements will be limited to $100.00 per day for per diem and incidentals unless approved by the Board.Purpose of Trip:* Location:* Upload the itinerary:*Max. file size: 49 MB.Dates of Travel:*(MM/DD/YYYY) - (MM/DD/YYYY) Do you have hotel costs?* Yes No What was your total cost for hotel? Upload copy of your hotel receipt.Max. file size: 49 MB.Do you have airfare costs?* Yes No What was your total cost for airfare? Upload copy of your airfare receipt.Max. file size: 49 MB.Do you have public transportation costs?*(for example: shuttle, taxi, etc...) Yes No What was your total cost for public transportation? Upload copy of your public transportation receipt(s).Max. file size: 49 MB.Do you have mileage costs?* Yes No Total your mileage to and from event and multiply that by $0.625. Enter that amount below. Do you have parking costs?* Yes No What your your total costs in parking? Upload copy of your parking receipt(s).Max. file size: 49 MB.Meals Per Diem AllowanceCalculate your per diem allowance for your event's location at http://www.gsa.gov/perdiemWhich meal(s), if any, are you claiming per diem for?*Check all that apply. None Breakfast Lunch Dinner BreakfastCheck all that apply. Day 1 Breakfast Day 2 Breakfast Day 3 Breakfast Day 4 Breakfast Day 5 Breakfast Day 6 Breakfast Day 7 Breakfast Total amount claimed for breakfast meal(s): LunchCheck all that apply. Day 1 Lunch Day 2 Lunch Day 3 Lunch Day 4 Lunch Day 5 Lunch Day 6 Lunch Day 7 Lunch Total amount claimed for lunch meal(s): DinnerCheck all that apply. Day 1 Dinner Day 2 Dinner Day 3 Dinner Day 4 Dinner Day 5 Dinner Day 6 Dinner Day 7 Dinner Total amount claimed for diner meal(s): The amount below is the total amount of your reimbursement: $0.00 By entering your name below, you are certifying that the statements, the amounts claimed and attachments are true, correct, and complete to the best of your knowledge and belief, and that the payment for the amount claimed has not been already received.* Enter your email address for confirmation:* Δ
