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                                                          Iowa Emergency Nurse’s Association

REIMBURSABLE EXPENSE ACCOUNT

 

Expense Incurred by: ___________________________________________________________

Complete Address: ____________________________________________________________

Purpose and Date(s):  ___________________________________________________________

   TYPE OF EXPENSE

 

 

               DATES

 

  TOTAL

(Please Attach Receipts)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Travel    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOTEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MEALS        - Breakfast

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*See            - Lunch

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Below        - Dinner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Transportation

Costs/Parking

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registration Fees

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office supplies (stamps, envelopes, paper, other):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Catering

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other: (Explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAILY TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that this is a true statement of my expenses incurred on official business for the State Emergency Nurse’s Association. (Please attach receipts)

 

Signature:                           _____________________              Date: ___________________                  

 

 

Approved by:                                                                                   Date:

 

     Travel Expense Guidelines

INSTRUCTIONS:  PLEASE BE GUIDED BY LIMITATIONS LISTED ON THIS FORM

This form is designed to provide for seven days of expenses.  The first column is provided for the first day, etc., until a full week is ended or the trip is completed.  Please enter dates at the head of the appropriate column. 

Itemized receipts are to be attached. This includes hotel bills in all cases. Under hotel only the actual cost of lodgings is to be entered. Other items on the hotel bill must be entered in the appropriate place.

Authorized travel expenses incurred on ENA business will be reimbursed by the State ENA Council according to the following restrictions:

bullet Meals are to be entered as shown.
bullet Meals are reimbursed, including gratuities.
bullet All unusual items are to be explained in full and receipts attached where possible
bullet A mileage allowance or the cost of public transportation is authorized.  Out-of-state travel will be reimbursed on the basis of commercial tourist class air transportation plus appropriate taxi or limousine. 
bullet Reimbursement by any other means than that described above must be authorized in advance by the ENA State Council.  (Included in this limitation is car rental.  In-state airfare, with the cost in excess of reimbursement of personal auto travel, must also be approved in advance).

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