ATHLETE TRAVEL REIMBURSEMENT FORM by rJzlM9

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									                ATHLETE TRAVEL REIMBURSEMENT FORM

ATHLETE NAME:____________________________________________________

USA SWIMMING REG# ________________________ PHONE: _______________

PAY TO ORDER OF NAME FOR CHECK: _________________________________

SEND CHECK TO ADDRESS: __________________________________________

                                   __________________________________________

CLUB: ________________________ COACH: _____________________________

NAME OF MEET:__________________________ DATE(S):___________________

MEET LOCATION: ____________________________________________________
Fill in Reimbursement Request below. Write Ref# on receipt. List each meal
separately, include date.
 Ref# Description                                              Amount Claimed
 1        Commercial travel Air/Train/Bus
 2        Personal Auto Travel _______miles @$.30/mile
 3        Lodging from ___________ to _____________
 4
 5
 6
 7
 8
 9
 10
 11
 12
 13
 14
 15
 16
 XXX Carry over amount from attached sheet(s) if required

                                      TOTAL REQUESTED: $__________________
Required Attachments: Meet results (pages with your name/results) and receipts.
SUBMIT TO NMS TREASURER WITHIN THIRTY (30) DAYS AFTER EVENT.
New Mexico Swimming will reimburse swimmers the amount allowed by the “New Mexico Swimming
Rules and Regulations Manual Section 11.0. Information is available on the NM Swimming web site:
www.nmswim.org Swimmers must also furnish a copy of meet results to the NMS Computer Chairman.
I Certify the above requested amounts are valid costs incurred traveling for the listed meet, and
are not being reimbursed from any other source.

Date: ____________________ Signature of Traveler:_____________________________


               N M SWIMMING RULES AND REGULATIONS MANUAL 4 July 2004 Page 35
            ATHLETE TRAVEL REIMBURSEMENT FORM
                          PAGE 2
SWIMMERS NAME: ________________________         TRAVEL DATES: ______________


Ref#   Description                                           Amount Claimed
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

                                       TOTAL THIS PAGE: $_________________

                                  Write this amount in space provided on page one

           N M SWIMMING RULES AND REGULATIONS MANUAL 4 July 2004 Page 36

								
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