Tampa Bay Area Chapter
CHAPTER SUBSIDY REIMBURSEMENT REQUEST Type:
Class/Seminar
FAPPO Conf
NIGP Forum
Other (specify)
Description/Title: Name: Mail Address: City/State/Zip: Phone / Fax: Email: Entity:
Event Registration Fee 40% Subsidy Reimbursement Request (Not including late fees)
$ $
Course Paid By Make Reimbursement Check Payable to: (If reimbursement is to be paid to a Chapter Member (by signing below) I certify that agency funds were not used to pay for this registration.) Member Signature: Member’s Manager:
Manager’s Printed Name: Date:
Board Use Only: ____Approved as submitted
02/15/2017 Date: ___________________
_____Approved w/changes
_____Denied
Reviewer: __________________________
(Rev 6/21/2016)
Class/Seminar
FAPPO Conf
NIGP Forum
Other (specify)
Description/Title: Name: Mail Address: City/State/Zip: Phone / Fax: Email: Entity:
Event Registration Fee 40% Subsidy Reimbursement Request (Not including late fees)
$ $
Course Paid By Make Reimbursement Check Payable to: (If reimbursement is to be paid to a Chapter Member (by signing below) I certify that agency funds were not used to pay for this registration.) Member Signature: Member’s Manager:
Manager’s Printed Name: Date:
Board Use Only: ____Approved as submitted
02/15/2017 Date: ___________________
_____Approved w/changes
_____Denied
Reviewer: __________________________
(Rev 6/21/2016)
