Travel Authorization by Levone

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									TRAVEL REQUEST FORM

TRAVEL Request Form Coast-to-Coast Chapters AACN Waves of Wisdom 2009 July 23 & 24, 2009 DUE NO LATER THAN MARCH 1, 2009

AIR TRAVEL & AIRPORT/HOTEL TRANSFERS: To contain travel expenses, speakers are expected to make air travel reservations no later than March 1, 2009. Speakers are responsible for making their own reservations for air travel but must submit the travel information by the March 1, 2009 so that Coastto-Coast Chapters AACN may schedule appropriate hotel transfers via private vehicle (Coast-to-Coast Chapters AACN will not reimburse transfers or taxi service). If no form is submitted by March 1, 2009, Coast-to-Coast Chapters AACN will reimburse flight cost from the airport nearest the speaker’s home to the Orlando International Airport (MCO) at no greater than $400.00. Speakers will submit a Speaker Expense Report with receipt for air travel at the close of the conference or via mail no later than August 1, 2009. HOTEL ROOM REQUEST Coast-to-Coast Chapters AACN will provide a complimentary room for speakers on the night before and/or the night of your speaking date. Coast-to-Coast Chapters AACN will make and pay for your room reservation. Speakers who desire a room must submit this room request form by March 1, 2009. Any speaker not returning the request form by March 1, 2009 will not receive a complimentary room. Speakers may be required to supply a credit card number to the hotel for incidental expenses. Please ensure that your receipt upon checkout includes only your own incidental expenses. MILEAGE (ONLY SPEAKERS TRAVELING > 50 MILES TO THE CONFERENCE SITE) Speakers traveling by personal car from greater than 50 miles from the conference site may request mileage reimbursement at a rate of 58.5 cents per mile. Mileage must be noted on this request form and submitted no later than March 1, 2009. Requests made after this date will not be honored. MEALS: Coast-to-Coast Chapters AACN will provide continental breakfast, snacks and luncheon to all speakers during the conference. Other meal service is on your own.

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TRAVEL REQUEST FORM SPEAKER NAME: AIR TRAVEL INFORMATION:
Airline: Departure City: Arrival City: (Orlando International Airport—MCO) Arrival Flight Number: Arrival Flight Date: Flight Arrival Time: Transfer to Hotel Required? YES NO Departure Date: Departure Flight Number: Departure Time: Airline: Transfer to Airport Required from Hotel? Flight Cost: $___________________ Confirmed Date:

YES

NO

ROOM REQUEST

I am requesting the following complimentary room nights: (please check the appropriate date(s) not to exceed _____Wednesday, July 22, 2009 _____Thursday, July 23, 2009 _____Friday, July, 24, 2009
2 room nights)

Mileage Request

I am traveling greater than 50 miles to speak at Waves of Wisdom 2009. I request reimbursement for mileage as follows: _____miles Departure Address:

OTHER REQUESTS:
If a special room type is required, please indicate. Oth

Dietary Requests:
Please indicate any specific dietary needs.

Return by March 1, 2009

Email: lorna.baker@moffitt.org OR Mail: 1052 Standing Reed Place, Wesley Chapel, FL 33543 OR Fax: Attn: Lorna baker, Coast-to-Coast Chapters AACN 813-745-5524

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