EXPENSE REIMBURSEMENT/CHECK REQUEST

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					        EXPENSE REIMBURSEMENT/CHECK REQUEST




             American Society of Safety Engineers
                   Oklahoma City Chapter

DATE:                            SUBMITTED BY (print):              _____

                                 SIGNATURE: _____________________________


AMOUNT TO BE PAID:               $


MAKE CHECK PAYABLE TO:                                              _____


PURPOSE OF REQUEST:


APPROVED BY:        (1)                             (2)


                          EXPENSE REPORT SUMMARY

 DATE                DESCRIPTION OF EXPENSE                    AMOUNT




            TOTAL



Chapter Treasurer Use Only:

Date Paid                  Check #                  Amount $



2008-OKC-1

				
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