Capital District Reimbursement Form

"*" indicates required fields

Name*

First Last

Address*

Street Address City State ZIP Code

New Mailing Address

Please check this box if your mailing address has recently changed

Email*

Phone*

Organization*

Approved by DA?*

Source of CKI Funds

Office Held*

Expense Type*

Travel Expenses

Registration Cost

Meals Included

Airfare

Economy-class fare only

Automobile Roundtrip Mileage

Cannot exceed roundtrip economy airfare

Automobile Mileage Expense

Lodging Costs

Room rate and tax only

Miscellaneous Travel Expense

Parking, tolls, taxis, etc.

Miscellaneous Travel Detail

Total Travel Expenses*

Notes about Travel Expense

Other Expenses

Expense Amount

Expense Detail

Expense Amount

Expense Detail

Expense Amount

Expense Detail

Expense Amount

Expense Detail

Expense Amount

Expense Detail

Expense Amount

Expense Detail

Total Other Expenses*

Total Expense Reimbursement Requested*

Upload All Receipt Files

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Kids Need Kiwanis

Capital District Reimbursement Form

Travel Expenses

Other Expenses