Faculty Expense Form

TRAVEL REIMBURSEMENT EXPENSE LOG

 

 

CME Activity:  ___________________________ Date: ________                  

Presenter: ___________________________________________

 

 

Expenses

 

 

 

Amount

 

TRANSPORTATION

 

  

     Airfare  

 

 

  

     Mileage (include addresses traveled from)

 

$

 

     Taxi (to & from airport)                                         

$

  

     Parking/Tolls

$

 

 

MEALS                                                                   

$

 

 

HOTEL EXPENSE                              

$

 

 

HONORARIUM

 (Include signed honorarium form & W-9, if not already submitted.)                  

$

 

 

OTHER (please indicate)

$

 

TOTAL:

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please attach ORIGINAL receipts and submit to:

EVMS-CME
358 Mowbray Arch
Suite 207
Norfolk, VA 23507

 

 

Thank you!