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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
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I have read the reimbursement policy
This request for reimbursement is for expenses incurred in connection with:
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Certified Bankruptcy Assistant Program
Professional Skills Seminar
Official ABJA Business
While participating as a
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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
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Last Name
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Street Address
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Address Line 2
City
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State/Country/Region
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Guam
Puerto Rico
US Virgin Islands
Zip Code
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Phone Number
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Preferred Email Address
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Airfare
Hotel
Parking
No. of POV Miles
No. Miles x 0.67
Date
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Breakfast
Lunch
Dinner
Date
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Breakfast
Lunch
Dinner
Date
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Breakfast
Lunch
Dinner
Date
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Breakfast
Lunch
Dinner
Date
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Misc. Expense Description
Amount
Date
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Misc. Expense Description
Amount
Date
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Misc. Expense Description
Amount
Date
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Misc. Expense Description
Amount
Total
0.00
Calculate
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
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