ASSOCIATION OF BANKRUPTCY JUDICIAL ASSISTANTS

PLEASE READ EXPENSE REIMBURSEMENT POLICY AND PROCEDURES BEFORE COMPLETING FORM

http://www.abja.org/content/expense-reimbursement-policy

Please confirm *

I have read the reimbursement policy

This request for reimbursement is for expenses incurred in connection with: *

Certified Bankruptcy Assistant Program

Professional Skills Seminar

Official ABJA Business

While participating as a *

Member	Speaker/Presenter
Conference Chair/Co-Chair	CBA Chair/Co-Chair

If related to a conference, please provide the city and state of the conference

PLEASE MAKE CHECK PAYABLE TO (Complete all contact information)

First Name *

Last Name *

Street Address *

Address Line 2

City *

State/Country/Region *

Zip Code *

Phone Number *

Preferred Email Address *

Airfare

Hotel

Parking

No. of POV Miles

No. Miles x 0.67

Date +

Breakfast

Lunch

Dinner

Date +

Breakfast

Lunch

Dinner

Date +

Breakfast

Lunch

Dinner

Date +

Breakfast

Lunch

Dinner

Date +

Misc. Expense Description

Amount

Date +

Misc. Expense Description

Amount

Date +

Misc. Expense Description

Amount

Date +

Misc. Expense Description

Amount

Total

0.00

Comments:

Upload Receipt(s). Please combine receipts so there are no more than three files uploaded.

Submitted by

/s/ Electronic Signature (by typing name)

Title (officer/committee chair/speaker)

Date +