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YALSA Reimbursement Form

REQUEST FOR PAYMENT

TO: Beth Yoke, YALSA Executive Director

FR:

ADDR:

RE: Request for Payment of Expenses as a Result of Committee or Other Association Program Activity

DATE:

Purpose:

Itemized Expenses:

Submitted by:

Make check payable & mail to:(if different from the above)

Signature:

For YALSA OFFICE USE ONLY:

Budget Authority:

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SUB FUND
UNIT
ITEM
PROJECT Amount
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