Expense Reimbursement Form -Use this form to submit your expenses to the Club Treasurer. The procedure is to obtain the President's signature, then provide the completed form to the Club Treasurer.

Expense Reimbursement Form

Name : ________________________________ Date:_______________

Amount Requested: _____________________________________________

Make Check Payable to: _________________________________________

Mailing Address (if check to be mailed) : ___________________________

_____________________________________________________________

Budget Line Item: ______________________________________________

*Description of Expense: ________________________________________

_____________________________________________________________

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Approved: _____________________ Date:____________________________

*Please attach supporting documentation.

Check No.______________ Date: _______________ Amount:_____________

Rotary Club of Sandy Springs

PO Box 28894

Sandy Springs, Georgia 30358