TSA Travel Expense Report Form (See Travel Reimbursement Policy) Is this expense also eligible for reimbursement by another entity? Yes No If yes, please submit only expenses not covered by the other entity. Thank you. PAYMENT TO BE MADE TO: Name Street Address: City: State: Zip Code: Meeting Name & Date(S): Purpose: NATURE OF EXPENSES: Restricted coach airfare from (Departure City) to (Arrival City) on (date) and return. $ Mileage if personal car is used instead of air travel: Actual hotel room rate, including taxes X days (Not to exceed published meeting rate for double room. Does not include TSA Board Meetings, nor ASA Annual Meeting.) Other expenses (use Supplemental Expense Report Form) -- taxi, parking TOTAL EXPENSES WHEN APPLICABLE, RECEIPTS REQUIRED; PLEASE ATTACH TO THIS FORM; IF RECEIPTS ARE NOT ATTACHED, PAYMENT CANNOT BE PROVIDED. SUBMITTED BY: Date Name (TO BE SUBMITTED WITHIN 60 DAYS FOLLOWING MEETING) MAIL TO: TSA, 401 WEST 15TH STREET, SUITE 990, AUSTIN, TEXAS 78701 Approved _____________________________, TSA Treasurer, on _____________ (date) Paid by Check No. _________ on _____________ (date) in the amount of $__________ Charge against TSA Account _________________________________________________
