Expense Reimbursement and Honorarium

ASN Travel Expense Reimbursement

Expenses in connection with preapproved travel for ASN business will be reimbursed upon receipt of this form and detailed receipts. We ask that expenses are kept to a minimum whenever possible and that you provide all requested information so we may be in compliance with IRS regulations. Please include receipts for ALL expenses, whether seeking reimbursement or making a contribution to ASNF. Without receipts, we will be unable to issue a reimbursement or letter recognizing your donation for tax purposes.

This form must be returned within 30 days after the conclusion of the meeting or event to receive reimbursement. Reimbursement will not be provided if received after the deadline.

Step 1 of 2

Claimant's Personal Information

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address (Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

For international numbers, please scroll to the next field.

International Phone Number

Currency

This form assumes Reimbursement will be made in US dollars. Please note here if you have prepared this form using a different currency and note the type of currency. Also note if you require payment in a different currency and how we can best transfer funds to you.

US Dollars

Other Currency

Please indicate currency requested and how we can best transfer funds to you.

Select the nature of the reimbursement that you are seeking so we may direct this form to the attention of the appropriate ASN department:

Purpose of Travel(Required)

Be specific; include persons and/or organizations visited, reason for visit or meeting attended and event date

Date of Departure

Date of Return

Expenses

Please furnish all information requested – incomplete forms may not be reimbursed. When applicable, charges should be equitably adjusted to account for non-Society activities, such as business for other organizations or personal travel.

Air Travel Expense

ASN will reimburse the lowest available airfare that reasonably meets the business travel needs. If the airfare is over $600, please contact the ASN Executive office before purchasing.

Mileage Expense

Reimbursement for the use of a personal automobile on authorized travel will be at the standard mileage rate as determined by the IRS. For 2023, the IRS rate is 65.5 cents per mile. (Please visit www.irs.gov for current standard mileage rates.) Reimbursement for use of personal automobile cannot exceed the cost of the same travel by air.

Ground Transportation

Taxi, basic level ride share service or van service will be reimbursed to the traveler at actual cost plus up to a 20% tip. Subway, bus fares, tolls and parking fees (economy rate) will be reimbursed at actual cost.

Hotel Expense

ASN will reimburse the cost of a single occupancy hotel room and applicable taxes. Personal expenses such as laundry, valet, mini-bar, movies, etc. will not be reimbursed.

Meals

Actual costs for meals will be reimbursed up to a maximum allowance of $70.00 for each calendar day of travel. Detailed receipts must be provided.

Do you have other allowable expenses?(Required)

Personal expenses such as laundry, valet, travel insurance, telephone calls, internet, etc., are not allowable charges

Yes

Other Expense

ASN will reimburse the cost of a single occupancy hotel room and applicable taxes. Personal expenses such as laundry, valet, mini-bar, movies, etc. will not be reimbursed. Enter itemized description here:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Total(Required)

Select one:

Please consider the full amount a tax-deductible contribution to the ASN Foundation (ASNF).

Please consider $100 a tax-deductible contribution to ASNF and reimburse me for the remainder.

Please consider a different tax-deductible contribution to ANSF, listed by me below, and reimburse me for the remainder.

Hidden

Full Donation

Hidden

$100 Donation

My Tax-Deductibe Donation

Balance Due

Upload Your Receipts(Required)

Please include receipts for ALL expenses, whether seeking reimbursement or making a contribution to ASNF. Without receipts, we will be unable to issue a reimbursement or letter recognizing your donation for tax purposes. Upload your receipts in .pdf, .doc, .docx, .jpg, or .png format

Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, jpeg, Max. file size: 25 MB.

Expense Reimbursement Form

Step 1 of 2

Claimant's Personal Information

Your Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address (Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

For international numbers, please scroll to the next field.

International Phone Number

Currency

US Dollars

Other Currency

Please indicate currency requested and how we can best transfer funds to you.

Select the nature of the reimbursement that you are seeking so we may direct this form to the attention of the appropriate ASN department:

Purpose of Travel(Required)

Be specific; include persons and/or organizations visited, reason for visit or meeting attended and event date

Date of Departure

Date of Return

Expenses

Air Travel Expense

ASN will reimburse the lowest available airfare that reasonably meets the business travel needs. If the airfare is over $600, please contact the ASN Executive office before purchasing.

Mileage Expense

Ground Transportation

Hotel Expense

ASN will reimburse the cost of a single occupancy hotel room and applicable taxes. Personal expenses such as laundry, valet, mini-bar, movies, etc. will not be reimbursed.

Meals

Actual costs for meals will be reimbursed up to a maximum allowance of $70.00 for each calendar day of travel. Detailed receipts must be provided.

Do you have other allowable expenses?(Required)

Personal expenses such as laundry, valet, travel insurance, telephone calls, internet, etc., are not allowable charges

Yes

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Other

Itemized description:

Other Expense

Enter billable amount here:

Total(Required)

Select one:

Please consider the full amount a tax-deductible contribution to the ASN Foundation (ASNF).

Please consider $100 a tax-deductible contribution to ASNF and reimburse me for the remainder.

Please consider a different tax-deductible contribution to ANSF, listed by me below, and reimburse me for the remainder.

Hidden

Full Donation

Hidden

$100 Donation

My Tax-Deductibe Donation

Balance Due

Upload Your Receipts(Required)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, jpeg, Max. file size: 25 MB.