Travel Bursary Reimbursement Form: 2019

Complete the Travel Bursary Reimbursement Form and email it together with copies of your receipts to info@pharmacologycanada.org no later than 11:59 ET July 15, 2019.

Name:
Address:
Expense Description	Amount ($CDN)	Receipts Attached
Air travel	□
Rail travel	□
Road travel (______ km @0.38/km)
Parking	□
Accommodations	□
Other	□
Total Claim	$

______________________________________________	________________________

Signature of Claimant	Date (DD-MMM-YY)

If you’d prefer, you can also submit this form, together with receipts, by mail to:

Randee Holmes

Executive Director

CSPT Head Office

605 Arbor Road

Mississauga, ON L5G 2K1

All claims must be postmarked on or before July 15, 2019.