Respondent Reimbursement Form Respondent Reimbursement Form Respondent or Artist Seeking Reimbursement Name * Email * Work Phone Cell Phone Send Reimbursement to: Address Line 1: * Address Line 2: City: * State * Zip * Reimbursement Category * Please Select Associate Response Participating Response Other Production Information: (One production per form) Production name: * Date: * Location (City, State): * Producing Institution: * Associate Production(s): Online Response sheet(s) completed? * Yes Participating Production(s): Online Response sheet(s) and Written Response sheet completed? * Yes Other Reimbursements (One type per form) Reimbursement For: Select best option * Please Select Region 2 Festival Summer Planning Weekend Fall Planning Weekend Selection Weekend National Festival Summer National Meeting Other: Explain below Other: Explain Date(s) Travel Information (receipts required): Total Miles Driven in Personal Car (Numbers only) Personal car/gas expense @ $.40 per mile Do you have additional expenses? Yes Tolls (Dollar Amount Only) Parking (Dollar Amount Only) Taxi/Uber/Lift/Rideshare (Dollar Amount Only) Plane/Train/Bus fare (Dollar Amount Only) Other (Dollar Amounts Only) Other (Description) Total: Mapquest or googlemaps link here Please check all that apply: I have sent my receipts via "snail mail?" Yes N/A Upload scanned receipts (one file per box): Drop a file here or click to upload Choose File Maximum upload size: 256MB Drop a file here or click to upload Choose File Maximum upload size: 256MB Drop a file here or click to upload Choose File Maximum upload size: 256MB Drop a file here or click to upload Choose File Maximum upload size: 256MB Note that reimbursement will not be made until all required response forms have been received (if applicable) and expenses have been approved. Send receipts via mail toSuzanne DelleKCACTF Region II Chairc/o York College of Pennsylvania441 Country Club RoadYork, PA 17403 Additional Comments If you are human, leave this field blank.
