Pay To 
Name:
Company Name:
Address:
City, State, Zip:

      
       Transportation Expenses:  The Vera Institute will reimburse you for mileage, parking costs, ground transportation to 
       and from the airport and other travel related to the meeting in Providence.  Please attach original receipts after making 
       copies for your files.  Fill in only those that apply to you. 

Date:
To:                                                       From:
Amount:

Airport                                                   Home or Office        (cab or shuttle)


Hotel                                                     Airport                      (cab or shuttle)


Airport                                                   Hotel/meeting          (cab or shuttle)


Home or Office                                      Airport                     (cab or shuttle)


Other travel in Providence:





Parking Costs 


Mileage (48.5 cents/mile)


                                                                            Total Transportation Costs:


   Meal Expenses:  The Vera Institute will reimburse you for meals not provided during the meeting and meals bought
   during travel time.  Alcoholic beverages are not reimbursable. Please attach original receipts after making copies for 
   your files.  Fill in only those that apply to you.

Meal:
Amount:

Tuesday, May 8:  Meals during travel (up to $30 total)    

Wednesday, May 9: Dinner (up to $20)

Thursday, May 10: Dinner (up to $20)


Friday, May 11: Meals during travel (up to $18 total) 

Total Meal Expenses:



Signature: 


Internal use only:	VAWO ASI	  Approved by:____________________________________







For Fiscal Use Only: Date Paid: ______________		Check No._____