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A. Name of traveler.
B. Date form is completed.
C. Identify conference or meeting that will be attended.
D. City, State and building name or address.
E. Hotel name and location, if applicable. This does not need to be complete when the hotel is the same as the conference location listed on D.
F. Actual date meeting or conference will occur.
G. Meeting notification needs to be attached that states purpose of meeting and agenda.
H. If attendance requires traveling out of state ESD board must approve this in advance. Allow adequate time for board approval before travel.
I. Travel dates and estimated departure and return times.
J. Estimate of meal per diem that will be earned during travel. Do not include meals that are provided at part of conference or meeting.
K. Estimate of airfare costs. Leave blank if not applicable.
L. Conference registration fees. Leave blank if not applicable.
M. Estimate of rental car costs. Leave blank if not applicable.
N. Estimate mileage using mileage chart and current reimbursement rate.
O. Lodging per diem costs for location times number of days. Leave blank if not applicable. If costs are above perdiem indicate exemption number to rules as noted on the back of the form.
P. Total of J to O.
Q. Accounts codes to be charged for travel costs
Out of region form
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