Name:_____________________  Position Served:_______________

Address:____________________Phone: (H)_______________         __________________________            (W)__________________ 

Name of Company:_________________________________________________

Address: ________________________________________________

              
             _________________________________________________

Phone (if available): _______________________

Name of Company Representative:___________________________

Date of Transaction: ____________Invoice/Order No.:____________

Terms of Payment (if applicable)____________________________________

Complete description of and/or reason for expenditure

  Note:  To receive reimbursement or to have bill paid, copies of bills or invoices covering the full amount must be attached.

Yes       No  (Circle one) Does this voucher describe an expense related to the planning
                                        or implementation of the Fall Conference? 

Total Amount Claimed: __________________

For office Use

Check # ______         Voucher #__________   Category #_______    Date Paid ________

Approved By:_____________________________________