LUGOD Reimbursement Form Please return with receipt(s) to the Treasurer Neither receipts without form, nor form without receipts shall be accepted Your Name: ____________________________________________________ Mailing address: ____________________________________________________ Date: ____________________________________________________ Receipt # | Amount | Event description | Description of items bought __________|__________|_____________________|________________________________ | | | 1 | $ | | | | | 2 | $ | | | | | 3 | $ | | | | | 4 | $ | | | | | 5 | $ | | | | | 6 | $ | | | | | 7 | $ | | | | | 8 | $ | | | | | 9 | $ | | | | | 10 | $ | | | | | __________|__________|_____________________|________________________________ Total: $_______ Number of receipts: ________ Additional information, if needed: