Oregon Trails Walk to Emmaus

REQUEST FOR REIMBURSEMENT

Please check which event this reimbursement is requested for:

q Men’s Walk # ___

q Women’s Walk # ___

q Boy’s Chrysalis # ___

q Girl’s Chrysalis # ___

q Administrative

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EXPENSE FOR WHAT TEAM: _______________________

EXPENSE: AMOUNT

________________________________ ___________

________________________________ ___________

________________________________ ___________

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TOTAL ___________

Please be specific in describing your expense- please include bills and receipts

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Name: ______________________ Date: ___________

Title: ______________________

Signature: _________________________________

Make Payment To: _________________________

Mail To: _________________________

_________________________

REQUESTS MUST BE SUBMITTED WITHIN 30 DAYS OF EVENT.

Submit Requests to: Earl Pickett , O.T.W.T.E. Treasurer

2765 NW John Olsen Avenue, #G92

  Hillsboro, Oregon 97124