Virginia Athletic Trainers' Association

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VATA TRAVEL REIMBURSEMENT REQUEST
(* indicates a required field or section)

REASON FOR REIMBURSEMENT *

	EC & Committee Chairs Travel to EC Meetings

	Other Pre-approved Official VATA Business
	Please provide details:

REIMBURSEMENT DETAILS

Purpose of Travel:

Destination:

Date of Travel:
(mm/dd/yyyy)

Number of Miles:

@ $0.35/mile = $

Other Approved Expenses: (e.g., hotel fees)

Reimbursement Total: *

REQUESTOR INFORMATION

Name of Person Requesting Reimbursement: *

VATA Affiliation: *

Date: *

Phone: *

ADDRESS FOR CHECK MAILING

Street Address: *

City: *

State: *

Zip Code: *

For more information or if you have any questions, please email info@vata.us.
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