DREI'99 Travel Reimbursement Form

Name (please print):__________________________________________________________

Email address:________________________________________________________________

Address to which check should be mailed:______________________________________

______________________________________________________________________________

______________________________________________________________________________

Dates of Attendance:__________________________________________________________


To process your reimbursement you MUST do the following:     

   1.Attach ORIGINAL receipts
   2.Sign this form at bottom
   3.Return reimbursement form and receipts to:

        DIMACS, CoRE Bldg., Rm. 412
        Rutgers, The State University of New Jersey
        96 Frelinghuysen Road
        Piscataway, NJ 08854-8018
        Attn: Barbara Kaplan, Financial Assistant
	Questions Contact:bkaplan@dimacs.rutgers.edu

             
       (Note: reimbursements take approximately four weeks to process.)



Airfare (U.S. airline only):______________________________________________

Mileage (@25 cents per mile):_____________________________________________

    Starting point:______________________________________________

    Destination:_________________________________________________

Other costs (describe item and enter amount on same line):
Item#1:______________________________________________________________________

Item#2:______________________________________________________________________

Item#3:______________________________________________________________________

Item#4:______________________________________________________________________

Item#5:______________________________________________________________________



I certify that the attached receipts are appropriate and accurate.




Signature

You may use this as a template - fill in the information, print it out,
sign the form, then mail it along with your original receipts, to me.